ARTHROTOMY VERSUS ARTHROSCOPY

What is arthrotomy or arthroscopy? “Arthro” means joint, and “otomy” means to cut. Canine arthrotomy involves a surgeon making a large incision to open the joint, inspecting it with the naked eye.

In contrast, canine arthroscopy involves a surgeon making small incision (about 3-5 mm) through which a camera, or scope, is inserted to project an image of the joint onto a screen. (“Arthro” means joint, and “scopy” means viewing with a scope.)

Which is better? In skilled hands, arthroscopy is superior. Let’s get into the details and see why.

Which provides a more thorough evaluation of the interior to the joint?

Arthroscopy. There is no debate about this among experts. Studies in veterinary medicine consistently demonstrate better visualization with arthroscopy compared to arthrotomy.

For instance, studies have demonstrated that arthroscopy offers a clearer view of the knee’s lateral compartment in dogs with cranial cruciate ligament (CCL) ruptures, which helps identify additional issues like canine meniscus tears. This detailed inspection can prevent persistent limping after procedures like TPLO by addressing any missed meniscal damage upfront.

In fact, a dog limping one year after TPLO surgery is often caused by unidentified meniscal damage—something more likely to be overlooked during an arthrotomy. With arthroscopy, however, veterinary orthopedic surgeons can more easily detect and treat meniscal tears and other issues during the initial TPLO procedure, minimizing the chances of post-surgical complications.

Why does arthroscopy provide superior visualization?

There are two reasons arthroscopy provides superior visualization of a joint. First, the surgeon can place the tip of the arthroscope (ie the camera) in locations that are inaccessible to the naked eye, and therefore cannot be seen without an arthroscope. Second, the image with arthroscopy is greatly magnified on the screen. This allows the veterinary surgeons to see more details of the dog’s joint structure, making it easier to identify meniscus tears or other joint damage, improving surgical outcomes.

Abbreviated video clips of arthroscopy in a healthy canine knee (above) and a canine knee with ACL rupture (below).

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Actual image of an arthrotomy on a canine knee. Note the large joint incision to gain exposure. This is in stark contrast to minimally invasive arthroscopy which requires only two small (pencil tip size) incisions.

Which results in less pain, arthrotomy or arthroscopy?

Arthroscopy. Unlike the large incision of an arthrotomy, arthroscopy requires only two small 3-5mm incisions to insert the ports for the camera and instruments. A study by Hoelzler et al. found that dogs who undergo arthroscopy and CCL rupture stabilization have less pain and better joint function than those treated with arthrotomy and CCL stabilization.

¹ Hoelzler, M. G., Millis, D. L., Francis, D. A., & Weigel, J. P. (2004). Results of arthroscopic versus open arthrotomy for surgical management of cranial cruciate ligament deficiency in dogs. Journal of the American Veterinary Medical Association, 224(12), 1852-1857.

Clinical relevance: “The results of this study suggest that short-term postoperative morbidity may be reduced in dogs receiving arthroscopic joint surgery with a limited approach for stifle stabilization as compared with a traditional open arthrotomy technique.”

Another study, from Evans R. et al., showed that dogs with elbow dysplasia treated with canine elbow arthroscopy recover better than those treated with arthrotomy.²

² Evans, R. B., Gordon-Evans, W., & Conzemius, M. (2008). Comparison of three methods for the management of fragmented medial coronoid process in the dog: A systematic review and meta-analysis. Veterinary and Comparative Orthopaedics and Traumatology, 21(2), 106-109.

Conclusions: “The results were that arthroscopy was superior to medial arthrotomy…”

Which is easier?

Arthrotomy. Any vet surgeon can perform an arthrotomy. However, only a portion of surgeons are skilled arthroscopists, because the ability to perform arthroscopy is a skill that requires a substantial time, training, and investment to develop.

Which costs more?

Arthroscopy. Arthrotomy requires only a scalpel blade. Arthroscopy, on the other hand, requires a capital investment of tens to hundreds of thousands of dollars depending upon the equipment manufacturer, and requires disposable tools for the majority of procedures.

Which provides better medical documentation?

Arthroscopy. Arthroscopy offers superior documentation of the status of the joint and treatments, through still pictures and videos. In most cases, clients are provided with visual records of their pet’s arthroscopy procedure, similar to the standards of practice in human medicine. Such documentation is rarely performed with arthrotomy.

Which is better, arthroscopy or arthrotomy?

Arthroscopy. No surgeon would claim arthrotomy is superior to arthroscopy for dogs when performed by a skilled arthroscopist. The debate that exists among veterinary surgeons centers around whether arthroscopy provides sufficient benefit to warrant the expense of equipment, the extra time required to set up the equipment (along with cleaning and sterilization) and the amount of time and work it takes to become skilled at arthroscopy. 

​Dr. Franklin has 10+ years of experience performing many thousands of arthroscopies. He is a Founding Fellow in Minimally Invasive Orthopedic Surgery and has published numerous articles on arthroscopy. He is also he  co-editing a new textbook on veterinary arthroscopy. Dr. Franklin is a strong advocate for arthroscopy as a superior standard of care over arthrotomy. After all, available research shows that arthroscopy provides better surgical outcomes for pets, and Dr. Franklin strongly believes in providing the best veterinary surgical care for animals.