Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Meniscal Release 303

important after surgical treatment of the
CrCL-deficient stifle, since no current modality
affords the restoration of normal stifle kinemat-
ics (Kimet al.2012). Functional menisci may
contribute to improved stifle kinematics and
contact mechanics after surgery, while meniscal
release effectively eliminates the stabilizing
properties of the tissue. Loss of these critical
functions after meniscal release has severe
ramifications for the health and function of the
stifle joint. Since meniscal release is functionally
equivalent to meniscectomy, severe cartilage
degeneration can be expected (Fairbank 1948),
and anin vivo experimental study in dogs
showed that meniscal release in CrCL-intact
stifles resulted in severe articular cartilage
pathology as early as 12 weeks after surgery
(Lutheret al.2009) (Figures 36.2 and 36.3). In
addition, meniscal release alone was associated
with lameness, radiographic changes consistent
with osteoarthritis, and further meniscal dam-
age in these dogs (Lutheret al.2009). The effect
of meniscal release in a CrCL-deficient stifle
may be less evident, considering the abnormal
joint biomechanics caused by CrCL rupture.
However, it could be argued that for this reason
the meniscus should be preserved at any cost,
despite the risk of reoperation because of a
subsequent meniscal tear.

Surgical technique

Two types of meniscal release are routinely
performed. The abaxial or mid-body or central
meniscal release is performed by radial tran-
section of the meniscus immediately caudal
to the medial collateral ligament. The axial
or menisco-tibial ligament or caudal meniscal
release is characterized by a radial transection
at the junction of the menisco-tibial ligament
and the caudal pole of the medial meniscus
(Kennedyet al.2005) (see Chapter 35). Meniscal
release can be performed either through an
open approach or arthroscopically (Slocum &
Slocum 1998; Lutheret al.2009). Regardless
of approach, the basic principles of meniscal
surgery should be followed: (i) optimize expo-
sure and joint distraction before performing the
release; 2) use atraumatic surgical technique.
Exposure and assessment of the meniscus
is a crucial step in performing any meniscal

(B)

(A)

M

M

Figure 36.2 Photograph of right tibial plateau of

disarticulated right stifle 12 weeks after experimental

caudal menisco-tibial release (MR) in a stifle with an

intact cranial cruciate ligament (A) and sham surgery (B).

The metallic probe indicates the junction of the caudal

horn and the caudal meniscal ligament of the medial

meniscus, where MR was performed. Healing of the

caudal horn MR site was minimal and limited to the

abaxial region. Note the gross articular fibrillation on the

medial aspect of the tibial plateau. Medial meniscus (M).

Source: Lutheret al.2009. Reproduced with permission

from John Wiley & Sons, Inc.

treatment, including meniscal release. For

arthrotomy and arthroscopy, the combination

of joint distraction, femoro-tibial subluxation,

varus and valgus stress applied to the stifle

allows examination of the entire meniscus in

some cases (Pozziet al.2008). Improved expo-

sure can be achieved by using stifle distractors.

Exposure of the meniscus is more challenging

in the stable stifle with partial CR. In these

cases, debridement of the entire CrCL or expo-

sure of the caudal pole of the meniscus through

a caudo-medial approach should be considered

(Pozziet al.2008). After exposure, every region

of the meniscus is accurately probed to evaluate

its firmness, smoothness, and for the presence

of tears (Pozziet al.2008). Latent tears may