Facilitation of arthroscopic visualization and treatment of meniscal tears using a stifle joint distractor in the dog

Abstract

Background: Stifle arthroscopy has been described to have high sensitivity and specificity in the evaluation of menisci in dogs, particularly for the medial meniscus. However, the visualization of menisci can be difficult. The use of femoral distractors in human medicine has been described to simplify demanding surgical procedures, such as meniscus transplantation. In veterinary medicine, stifle distraction has been reported to facilitate access to the joint and visualization of intra-articular structures, but there are no studies reporting the use of a stifle distraction technique while performing challenging surgical procedures, such as meniscal suture, in clinical patients. The objective of this study was to evaluate the feasibility, effectiveness and safety of stifle distraction to achieve consistent visualization of menisci and to facilitate performing arthroscopic procedures in clinical patients with stifle disease. Initial arthroscopic evaluation of the stifle joint was performed without distraction in the study population consisting of 13 dogs with naturally occurring stifle disease. The criteria for inclusion was prospectively set as the observation of a frank disease or anomaly of the menisci that could not be further treated or clarified without the risk of damaging the joint cartilage due to the requested manoeuvres. After the first examination, distraction was applied in order to complete the assessment of menisci. After achieving an accurate diagnosis, partial meniscectomy or meniscal repair was performed as needed while maintaining the distraction. Results: Complete visualization and assessment of menisci were achieved thanks to the use of distraction. This manoeuvre facilitated access to the required area of the involved meniscus, and meniscal treatment could be successfully performed without damaging the articular cartilage. During the follow-up period, no postoperative complication related to the distraction or to the arthroscopic procedure was observed. Conclusions: Stifle joint distraction during arthroscopy in dogs improves visualization of both menisci, and particularly the caudal horn of the medial meniscus. Despite being a subjective assessment, it is the authors’ opinion that this procedure also increases the ease of performing challenging procedures like meniscal suture, as it enlarges the space available to reach the correct working angulations.