Page 105 - Clinical Manual of Small Animal Endosurgery

Operative Arthroscopy 93

When surgically managing cranial cruciate ligament disease in dogs,
current opinion is divided as to the magnitude of any measurable clinical
benefit to performing arthroscopic debridement of the cranial cruciate
ligament and arthroscopic medial meniscal surgery prior to an open
procedure such as TPLO. Proponents of arthroscopic investigation to
treat the intra-articular component of cruciate disease in dogs suggest
that the rate of occurrence of ‘late’ postoperative medial meniscal tears
is lowered by arthroscopic investigation (Thieman et al., 2006). Other
workers have not found evidence to support the benefit of arthroscopic
inspection of the menisci when compared to instrumented meniscal
inspection by limited arthrotomy (Fitzpatrick and Solano, 2010). It is
likely that while stifle stabilisation is performed using traditional open
procedures (such as TPLO), any potential for reduction in surgical
morbidity through arthroscopic inspection and treatment of the joint
is masked by the morbidity of the traditional open stabilisation proce-
dure. In the future, as arthroscopically assisted minimally invasive
approaches to stifle stabilisation of the cranial-cruciate-ligament-deficient
stifle joint become established (Cook et al., 2010), the potential for
reduced surgical morbidity through arthroscopic treatment of the stifle
joint will be evaluated.

Arthroscopically assisted surgery of OCD of the stifle joint
OCD lesions occur can occur on both the lateral and the medial femoral
condyle, although the lesions are observed more commonly on the lateral
condyle. Affected dogs often have marked stifle effusion and pain. The
arthroscopic portals used for arthroscopic surgery for OCD are as previ-
ously described and a stifle-distracting device is recommended to open
the joint space, reducing the extent of fat-pad debridement required to
inspect and work on the OCD lesion. For the surgical techniques, the
reader is asked to refer to those described for shoulder OCD.
The meniscus beneath the OCD lesion should be carefully inspected
visually, assisted with instrumentation, for signs of injury since meniscal
tearing is not uncommon with stifle OCD. Tears should be treated by
ablation as described above (Bertrand et al., 1997). Prior to completion
of the arthroscopy, the opposite femoral condyle and underlying menis-
cus should be checked for evidence of disease and treated appropriately,
if required. An intra-articular injection of ropivacaine (2 mg/kg) with
morphine (0.1 mg/kg) should be given to augment the postoperative
analgesia protocol.
Autogenous osteochondral grafting is an emerging treatment for
osteochondral defects affecting the femoral condyle (Cook et al., 2008).
The technique transfers dowels of articular cartilage with underlying
subchondral bone from the non-weight-bearing sulcus terminalis of the
medial and lateral femoral trochlear ridges into the OCD lesion in the
femoral condyle. Currently the technique is performed using an open
approach, but if long-term clinical results prove clinical efficacy then