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The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review.

ABSTRACT: Purpose:Arthroscopic surgery has become an important and popular orthopedic procedure for numerous joint disorders. Continuous irrigation is performed to replace synovial fluid for optimal joint distension and clear visualization of the synovial cavity. Irrigation solutions may, however, negatively impact articular cartilage and chondrocyte viability. This systematic review aims to compare different irrigating solutions and their properties to determine whether one is superior in its effects on articular cartilage and chondrocytes. Methods:A systematic literature review was conducted. The online databases: Embase, Medline, HealthStar, Emcare and PubMed were searched from 1946 to August 2018. Methodological index for non-randomized studies (MINORS) was used to assess methodological quality of the included studies. Results:Sixteen studies met the inclusion/exclusion criteria and were included in this review. Although the studies used different criteria to define superiority, solution superiority was based on results that focused on articular cartilage and chondrocyte viability. Seven of the sixteen included studies compared Ringer's/lactate solution or Ringer's lactate to normal saline. Three found Ringer's solution or Ringer's lactate to be superior to saline, whereas, three studies found no significant differences and one study found Ringer's lactate to be inferior to saline only when their osmolarities differed. Four studies compared ionic to non-ionic solutions. Two of the four studies demonstrated non-ionic solutions to be superior, one had demonstrated no significant differences between solutions, while one had mixed results. Six of the sixteen included studies compared differing osmolarities. One found no statistically significant differences between solutions of differing osmolarities, whereas, the remaining five studies found superiority with hyperosmolarity. Two of the sixteen included studies examined the effects of different temperatures. Both studies concluded that the use of a warmer (more physiological) temperature is more ideal. Two of the sixteen studies included in this review compared solutions with differing pH levels. Both studies concluded on the importance of utilizing the more physiological solutions for arthroscopic procedures. Conclusion:Ringer's Lactate and Ringer's Solution as well as non-ionic solutions may have merit over the use of the normal saline for irrigation. Hyperosmolarity, warmer solutions and ones with more physiological pH values may be beneficial when considering potential effects on articular cartilage and chondrocytes. The current review demonstrated trends found in the current literature, which require human studies - preferably high quality RCTs -to make recommendations that aid surgeons in making the best decision regarding the ideal irrigation solution to use on their patients. Level of evidence:Level IV, Systematic review of Level IV studies.

SUBMITTER: Sardana V

PROVIDER: S-EPMC6402300 | biostudies-literature | 2019 Mar-Apr

REPOSITORIES: biostudies-literature

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The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review.

Sardana Vandit V Burzynski Joanna J Scuderi Giles R GR

Journal of orthopaedics 20190228 2

<h4>Purpose</h4>Arthroscopic surgery has become an important and popular orthopedic procedure for numerous joint disorders. Continuous irrigation is performed to replace synovial fluid for optimal joint distension and clear visualization of the synovial cavity. Irrigation solutions may, however, negatively impact articular cartilage and chondrocyte viability. This systematic review aims to compare different irrigating solutions and their properties to determine whether one is superior in its eff ...[more]

PMID: 30886464

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Project description:Background: Meniscus tears are the most common injury in the knee and are associated with an increased risk of osteoarthritis (OA). The molecular profile of knees with meniscus tears is not well-studied. Therefore, to advance our understanding of the early response of the knee to injury, we compared the gene expression profile of meniscus and articular cartilage within the same knees following meniscus injury. Hypothesis/Purpose: To identify differences between the molecular signatures of meniscus and articular cartilage from knees with intact articular cartilage undergoing arthroscopic partial meniscectomy. Study Design: Descriptive laboratory study Methods: Patients (n=12) with a known isolated medial meniscus tear without any knee chondrosis or radiographic OA were consented prior to surgery. During arthroscopic partial meniscectomy, a sample of their injured meniscus and a sample of their articular cartilage off the medial femoral condyle were procured. The transcriptome signatures, as measured through Affymetrix microarray, were compared between the two tissues and underlying biological processes were explored computationally. Results: 3566 gene transcripts were differentially expressed between meniscus and articular cartilage. Gene transcripts down-regulated in articular cartilage were associated with extracellular matrix organization, wound healing, cell adhesion, and chemotaxis. Gene transcripts up-regulated in articular cartilage were associated with blood vessels morphogenesis and angiogenesis. Examples of individual genes with significant differences in expression between the two tissues include IBSP (23.76 fold; P < 0.001), upregulated in meniscus, and TREM1 (3.23 fold; P = 0.006), upregulated in meniscus. Conclusion: The meniscus and articular cartilage have distinct gene expression profiles in knees with meniscus tears and intact articular cartilage. Total RNA obtained from injured meniscus and normal articular cartilage from patients undergoing partial meniscectomy.

Project description:Articular cartilage is integral to the mechanical function of many joints in the body. When injured, cartilage lacks the capacity to self-heal, and thus, therapies and replacements have been developed in recent decades to treat damaged cartilage. Given that the primary function of articular cartilage is mechanical in nature, rigorous physical evaluation of cartilage tissues undergoing treatment and cartilage constructs intended for replacement is an absolute necessity. With the large number of groups developing cartilage tissue engineering strategies, however, a variety of mechanical testing protocols have been reported in the literature. This lack of consensus in testing methods makes comparison between studies difficult at times, and can lead to misinterpretation of data relative to native tissue. Therefore, the purpose of this study was to systematically review mechanical testing of articular cartilage and cartilage repair constructs over the past 10 years (January 2009-December 2018), to highlight the most common testing configurations, and to identify key testing parameters. For the most common tests, key parameters identified in this systematic review were validated by characterizing both cartilage tissue and hydrogels commonly used in cartilage tissue engineering. Our findings show that compression testing was the most common test performed (80.2%; 158/197), followed by evaluation of frictional properties (18.8%; 37/197). Upon further review of those studies performing compression testing, the various modes (ramp, stress relaxation, creep, dynamic) and testing configurations (unconfined, confined, in situ) are described and systematically reviewed for parameters, including strain rate, equilibrium time, and maximum strain. This systematic analysis revealed considerable variability in testing methods. Our validation testing studies showed that such variations in testing criteria could have large implications on reported outcome parameters (e.g., modulus) and the interpretation of findings from these studies. This analysis is carried out for all common testing methods, followed by a discussion of less common trends and directions in the mechanical evaluation of cartilage tissues and constructs. Overall, this work may serve as a guide for cartilage tissue engineers seeking to rigorously evaluate the physical properties of their novel treatment strategies. Impact Statement Articular cartilage tissue engineering has made significant strides with regard to treatments and replacements for injured tissue. The evaluation of these approaches typically involves mechanical testing, yet the plethora of testing techniques makes comparisons between studies difficult, and often leads to misinterpretation of data compared with native tissue. This study serves as a guide for the mechanical testing of cartilage tissues and constructs, highlighting recent trends in test conditions and validating these common procedures. Cartilage tissue engineers, especially those unfamiliar with mechanical testing protocols, will benefit from this study in their quest to physically evaluate novel treatment and regeneration approaches.

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The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review.

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The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review.

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