Damage to the medial meniscus is the single most common concurrent injury associated with CrCL rupture. Failure to appropriately manage meniscal injuries is a common reason for a poor outcome of a surgical procedure.

The caudal horn of the medial meniscus is attached to the tibial plateau. One consequence is that the caudal horn moves with the tibia underneath the femur during the excessive motion of the CrCL deficient stifle. Impingement of the femur on the caudal horn can cause damage ranging from bucket handle detachments to maceration. The lateral meniscus has an attachment to the distal femur and therefore moves with it avoiding impingement. Damage to the lateral meniscus is rare but worth looking for as examination is relatively easy.

• Damage to the medial meniscus is most common in large dogs with a long standing injury. Conversely small dogs with recent injuries are rarely affected.

• Examination of the medial meniscus is difficult, particularly via a lateral arthrotomy.

• There are currently two main approaches to the management of the medial meniscus in the CrCL compromised stifle.

Conventional: The meniscus is examined during surgery and damaged portions are removed.

Meniscal release: It is presumed that damage, if not already present, will occur and the caudal horn is sectioned to allow it to move caudally effectively removing it from harm by the femur. No meniscus is better than a damaged one seems to be the idea.

Both approaches require that the medial meniscus is exposed and examined for injury. This may be acheived by either:

Stifle distraction where the femur and tibia are forced apart the tibia brought forward Leverage where the tibia is levered cranially

There are advocates of both techniques but it would seem reasonable to leave an un-damaged meniscus in situ.

Meniscus Probes are very helpful in determining the status of the meniscus. Tears and detachments can appear normal until gently manipulated. The meniscus is very difficult to grasp without Cartilage Clamps or Toothed Halsteads. Excision of damaged areas or a meniscal release is best achieved using a Beaver Handle and Beaver blades #65(pointed) or #64 (round ended).

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