Nicholas M Capito1, Matthew J Smith2, Aaron M Stoker2, Nikki Werner2, James L Cook2. 1. Department of Orthopaedics, University of Missouri, Columbia, MO, USA. Electronic address: capiton@health.missouri.edu. 2. Department of Orthopaedics, University of Missouri, Columbia, MO, USA.
Abstract
BACKGROUND: A hyperosmolar irrigation solution may decrease fluid extravasation during arthroscopic procedures. Demonstrating the safety of a hyperosmolar irrigation solution with respect to chondrocyte viability and cartilage water content was deemed necessary before designing a clinical efficacy study. METHODS: We designed a translational animal model study in which hyperosmolar arthroscopy irrigation fluid (1.8%, 600 mOsm/L) was compared with normal saline (0.9%, 300 mOsm/L). Purpose-bred research dogs (n = 5) underwent bilateral shoulder arthroscopy. Irrigation fluid was delivered to each shoulder joint (n = 10) at 40 mm Hg for 120 minutes using standard ingress and egress portals. The percentage change in shoulder girth was documented at the completion of 120 minutes. Articular cartilage sections from the glenoid and humeral head were harvested from both shoulders. Chondrocyte viability and tissue water content were evaluated. Differences between groups and compared with time 0 controls were determined, with significance set at P <.05. RESULTS: The mean percentage change in shoulder girth was higher in the isotonic control group (13.3%) than in the hyperosmolar group (10.4%). Chondrocyte viability and tissue water content for glenoid and humeral head cartilage were well maintained in both treatment groups, and differences were not statistically significant. CONCLUSIONS: The data from this study suggest that doubling the osmolarity of the standard irrigation solution used for arthroscopy was not associated with any detrimental effects on chondrocyte viability or tissue water content after 2 hours of arthroscopic irrigation. On the basis of potential benefits in conjunction with the safety demonstrated in these data, clinical evaluation of a hyperosmolar solution for irrigation during shoulder arthroscopy appears warranted.
BACKGROUND: A hyperosmolar irrigation solution may decrease fluid extravasation during arthroscopic procedures. Demonstrating the safety of a hyperosmolar irrigation solution with respect to chondrocyte viability and cartilage water content was deemed necessary before designing a clinical efficacy study. METHODS: We designed a translational animal model study in which hyperosmolar arthroscopy irrigation fluid (1.8%, 600 mOsm/L) was compared with normal saline (0.9%, 300 mOsm/L). Purpose-bred research dogs (n = 5) underwent bilateral shoulder arthroscopy. Irrigation fluid was delivered to each shoulder joint (n = 10) at 40 mm Hg for 120 minutes using standard ingress and egress portals. The percentage change in shoulder girth was documented at the completion of 120 minutes. Articular cartilage sections from the glenoid and humeral head were harvested from both shoulders. Chondrocyte viability and tissue water content were evaluated. Differences between groups and compared with time 0 controls were determined, with significance set at P <.05. RESULTS: The mean percentage change in shoulder girth was higher in the isotonic control group (13.3%) than in the hyperosmolar group (10.4%). Chondrocyte viability and tissue water content for glenoid and humeral head cartilage were well maintained in both treatment groups, and differences were not statistically significant. CONCLUSIONS: The data from this study suggest that doubling the osmolarity of the standard irrigation solution used for arthroscopy was not associated with any detrimental effects on chondrocyte viability or tissue water content after 2 hours of arthroscopic irrigation. On the basis of potential benefits in conjunction with the safety demonstrated in these data, clinical evaluation of a hyperosmolar solution for irrigation during shoulder arthroscopy appears warranted.
Authors: Venkat Boddapati; Michael C Fu; Benedict U Nwachukwu; Christopher L Camp; Andrea M Spiker; Riley J Williams; Anil S Ranawat Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-07-24 Impact factor: 4.342