Effects of irrigation fluid on human menisci: An experimental comparison of water, normal saline, and glycine

Mah, Edward; Lee, W.K.C.; Rt, Southwood; Carbone, A.; Leppard, P.J.

doi:10.1016/0749-8063(91)90073-7

Cited by 10 publications

(4 citation statements)

References 6 publications

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“…Discussion between two reviewers took place to address disagreements, and if needed, the senior author resolved issues related to study selection. Studies were included if they contained: [1] irrigating solutions; [2] implications for/focus on arthroscopy; [3] examination of the effects on articular cartilage/chondrocytes [4] joints of the extremities; [5] comparison(s) of different solutions or the same solution with different properties (such as temperature, osmolarity, or pH); [6] primary article; [7] short term exposure to irrigation fluids; and [8] full text. The following components were made part of the exclusion criteria: [1] studies lacking a comparator group; [2] studies without an arthroscopic focus; [3] studies focusing on epinephrine/norepinephrine; [4] studies focusing only on electrosurgery in arthroscopy; [5] studies not examining the effects on articular cartilage or chondrocytes; [6] studies that are not available or full-text not accessible; [7] conference proceedings or abstracts; and [8] literature reviews and case reports.…”

Section: Search Strategymentioning

confidence: 99%

“…49 Similar beneficial findings had been noted by Parodi et al, with warmed irrigating solutions used during hip arthroscopy reducing the risk of decreased core body temperature. 50 Furthermore, one study found that irrigation with a cold solution (colder than body temperature) has resulted in human meniscal changes, 3 and it would be useful, for our purposes, to know whether one might expect the surrounding tissue to demonstrate such detrimental changes as well.…”

Section: Temperaturementioning

confidence: 99%

“…2 Since articular cartilage is dependent on the synovial fluid for its nutrition, it is sensitive to these changes. 3,4 Irrigation fluids used during arthroscopic surgery may result in increased elimination of proteoglycans out of the tissue, subjecting articular cartilage to potential mechanical injury 5 and resulting in matrix degradation and chondrocyte death. [6][7][8] Articular cartilage chondrocytes are, however, crucial to the synthesis of the proteoglycan and collagen of the extracellular matrix, as well as the essential enzymes for building and degrading them.…”

Section: Introductionmentioning

confidence: 99%

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

Sardana

Burzynski

Scuderi

2019

Journal of Orthopaedics

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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.

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Section: Search Strategymentioning

confidence: 99%

Section: Temperaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Sardana

Burzynski

Scuderi

2019

Journal of Orthopaedics

View full text Add to dashboard Cite

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“…Cartilage tissue is in a strong relationship with the surrounding organic environment and is particularly sensitive to small alterations in features such as oxygen saturation, heat and pH [3, 7, 11, 14]. Arthroscopy is the preferred method for joint surgery, but there the environment changes quickly as the synovial fluid is replaced by an irrigation solution, such as saline and Ringer's lactate [3].…”

Section: Introductionmentioning

confidence: 99%