Temperature changes and chondrocyte death during drilling in a bovine cartilage model and chondroprotection by modified irrigation solutions

Abstract

Reducing temperature during drilling by irrigation markedly suppressed, but did not abolish chondrocyte death. Optimising the irrigation solution by raising osmolarity and reducing Ca(2+) content significantly reduced chondrocyte death during drilling and may be clinically beneficial.

Subchondral drilling for articular cartilage repair: a systematic review of translational research

“…As a by-product of the drilling process, the possibility of thermal osteonecrosis is a concern when applying subchondral drilling during either open arthrotomy or dry arthroscopy ( Alam et al, 2015 ). Farhan-Alanie and Hall showed temperature changes and chondrocyte death during drilling in a bovine metatarsophageal joint and demonstrated that application of a modified irrigation solution enabled chondroprotection ( Farhan-Alanie and Hall, 2014 ). In this systematic review, only 5 studies described the heat protection step with constant irrigation with precooled sterile Ringer lactate solution ( Chen et al, 2013a , b ; Chen et al, 2011a , b , 2009 ).…”

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

“…43,44 One study found that during drilling, chondrocyte death was significantly reduced by raising osmolarity and reducing Ca2+ content. 45 The results in the included study by Amin et al showed that the effects of medium osmolarity are most pronounced in the superficial zone due to cell volume, with the superficial zone containing the most water content and permeability. 21 As a result, the chondroprotective mechanism of high osmolarity may be water efflux from cells, causing decreased chondrocyte volume.…”

Iatrogenic articular cartilage injury: the elephant in the operating theatre

“…[ [5,7]] This theory is supported by an in vitro study where chondrocyte death during drilling for screw fixation (due to thermal and mechanical trauma), is markedly reduced with copious irrigation with a hyperosmotic saline solution. [ [6]] The theory is also supported by in vivo (rat) experiments, which have demonstrated that hyperosmolar saline is chondroprotective against scalpel injury, presumably due to chondrocyte shrinkage. [ [7,8]…”

“…The iACI occurs because during this transient period of decreased osmolarity, the articular chondrocytes become much more susceptible to mechanical trauma, and this period also coincides with the actual arthroscopic surgical procedure. [ [4,6]] Such mechanical trauma occurs frequently during the surgical procedure, from scalpel blades, trochars, motorised shavers, arthroscopic instruments, cutters, drills, screws, implants or circular osteotomes, which are used to treat a variety of soft-tissue and articular pathologies. [ [3,6,7,8]] While the precise physiological rationale for this chondrocyte susceptibility to mechanical injury in hypo-osmolar environments still remains to be established, experimental studies in human and animal cartilage strongly suggest that this is due to chondrocyte swelling from the decreased extracellular osmolarity.…”

“…[ [4,6]] Such mechanical trauma occurs frequently during the surgical procedure, from scalpel blades, trochars, motorised shavers, arthroscopic instruments, cutters, drills, screws, implants or circular osteotomes, which are used to treat a variety of soft-tissue and articular pathologies. [ [3,6,7,8]] While the precise physiological rationale for this chondrocyte susceptibility to mechanical injury in hypo-osmolar environments still remains to be established, experimental studies in human and animal cartilage strongly suggest that this is due to chondrocyte swelling from the decreased extracellular osmolarity. [ [5,7]] This theory is supported by an in vitro study where chondrocyte death during drilling for screw fixation (due to thermal and mechanical trauma), is markedly reduced with copious irrigation with a hyperosmotic saline solution.…”