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Butt U, Aqeel Khan Z, Ali Ahmad Sheikh M, Stålman A, Vuletić F. Dry Knee Arthroscopy With Carbon Dioxide Insufflation for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2024; 13:102986. [PMID: 39100259 PMCID: PMC11293317 DOI: 10.1016/j.eats.2024.102986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/15/2024] [Indexed: 08/06/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are commonly treated through orthopaedic surgery, with traditional procedures relying on arthroscopy using fluid as the medium. However, dry arthroscopy has emerged as a potentially advantageous alternative technique. This method allows the knee joint to remain dry, reducing the risk of fluid leakage and enabling a more precise surgical visualization, resulting in shorter operation times and fewer complications. Recent research has highlighted the benefits of carbon dioxide (CO2) insufflation during ACL reconstruction, which can decrease pain and discomfort during early recovery. This article introduces a technique for performing ACL reconstruction that eliminates the need for arthroscopic fluid for visualization or instrumentation. Based on CO2 insufflation, this technique shows promise as a viable alternative to traditional fluid distention methods.
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Affiliation(s)
- Umer Butt
- Department of Trauma and Orthopaedic, AO Hospital, Karachi, Pakistan
- Sulis Hospital Bath, Bath, U.K
| | - Zainab Aqeel Khan
- Kantonsspital Baselland, Liestal, Switzerland
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Anders Stålman
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Capio Artro Clinic Sophiahemmet Private Hospital, Stockholm, Sweden
| | - Filip Vuletić
- Department for Orthopaedic and Trauma Surgery, University Hospital “Sveti Duh,” Sveti Duh, Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
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Penton JL, Flick TR, Savoie FH, Heard WM, Sherman WF. Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage-Based Procedures. Orthop J Sports Med 2021; 9:23259671211035454. [PMID: 34692876 PMCID: PMC8527579 DOI: 10.1177/23259671211035454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon's view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design Case series; level of evidence, 4. Methods A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients' electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.
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Affiliation(s)
- Judson L Penton
- Louisiana Orthopaedic Specialists, Lafayette, Louisiana, USA
| | - Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Felix H Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Wendell M Heard
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Wang C, Yang P, Zhang D, Zhang Y, Shen Y, Li H, Yu T, Qi C. [The effect of different continuous saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:178-182. [PMID: 33624470 DOI: 10.7507/1002-1892.202006134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of different saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee. Methods The clinical data of 539 patients with meniscus injury treated by arthroscopic menisci reformation who met the selection criteria between July 2016 and February 2020 were retrospectively analyzed. They were divided into three groups according to the continuous saline irrigation volume during the operation: 176 patients in the non-irrigation group (group A), 183 patients in the 1 liter-irrigation group (group B), and 180 patients in the 3 liters-irrigation group (group C). There was no significant difference in gender, age, cause of injury, sides of injury, body mass index, disease duration, smoking history, and classification of meniscus injury among 3 groups ( P>0.05). At 6, 12, 24, 48, and 72 hours after operation, the patient's pain level was evaluated by the visual analogue scale (VAS) score, and the knee swelling situation was evaluated by the swelling ratings (the difference between both sides in circumference of the 2 cm upper patella of the knee). Knee skin temperature (the difference of the skin temperature between both sides) and the C-reactive protein (CRP) level in serum were measured at the 1st and 3rd days after operation. Range of motion of the knee was measured at the 1st, 3rd, and 5th days after operation. Results All incisions healed by first intention without any complication after operation. The VAS scores of each group showed a slow increase trend after operation, and gradually decreased to less than the VAS score of 6 hours at 48 hours after operation. There was no significant difference in VAS scores among the 3 groups at each time point after operation ( P>0.05). The swelling ratings of the knee in each group showed a gradually decrease trend after operation. There was no significant difference in the swelling ratings of the knee among the 3 groups at each time point after operation ( P>0.05). The skin temperature of the knee in each group decreased at the 3rd day after operation than the 1st day, and there was no significant difference in the skin temperature of the knee among the 3 groups at each time point after operation ( P>0.05). There was no significant difference in CRP level within the group and among the 3 groups at each time point after operation ( P>0.05). Range of motion of the knee in each group increased gradually at the 1st, 3rd, and 5th days after operation, and there was no significant difference among the 3 groups at each time point after operation ( P>0.05). Conclusion The different continuous saline irrigation volume would not affect the early postoperative pain, swelling, and inflammation of the knee during the arthroscopic menisci plasty.
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Affiliation(s)
- Chen Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Pu Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Dongfang Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Yi Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Youliang Shen
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Haifeng Li
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Tengbo Yu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
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Hagmeijer MH, Vonk LA, Kouwenhoven JW, Custers RJ, Bleys RL, Krych AJ, Saris DB. Surgical Feasibility of a One-Stage Cell-Based Arthroscopic Procedure for Meniscus Regeneration: A Cadaveric Study. Tissue Eng Part C Methods 2018; 24:688-696. [PMID: 30398399 PMCID: PMC7615694 DOI: 10.1089/ten.tec.2018.0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPACT STATEMENT Meniscus injury remains the most common indication for orthopedic surgery, but loss of functioning meniscus tissue is strongly correlated with development of early osteoarthritis. However, current clinical options for tissue engineering of the meniscus are limited. This study demonstrates the feasibility of combining human meniscus cells with mesenchymal stromal cells to enhance a meniscus scaffold for meniscus regeneration in a one-stage solution for partial meniscal deficiency.
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Affiliation(s)
- Michella H. Hagmeijer
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lucienne A. Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan-Willem Kouwenhoven
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald L. Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aaron J. Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel B.F. Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
- MIRA Institute for Technical Medicine, University Twente, Enschede, The Netherlands. Investigation performed at the University Medical Center Utrecht, Utrecht, The Netherlands
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Mirzayan R, Cooper JD, Chahla J. Carbon Dioxide Insufflation of the Knee in the Treatment of Full-Thickness Chondral Defects With Micronized Human Articular Cartilage. Arthrosc Tech 2018; 7:e969-e973. [PMID: 30666290 PMCID: PMC6205084 DOI: 10.1016/j.eats.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/27/2018] [Indexed: 02/03/2023] Open
Abstract
BioCartilage (BC) is dehydrated, minced human hyaline articular cartilage that was developed as an adjunct to microfracture surgery to help stimulate the bone marrow and stem cells to form hyaline-like tissue in full-thickness chondral defects. The minced pieces of BC require a dry environment for application and can easily be disrupted by residual moisture of saline solution in the surrounding tissues. We present a technique of carbon dioxide insufflation during knee arthroscopy as a means of maintaining a dry environment for preparation of the bony bed during BC augmentation of microfracture surgery. This technique is safe and provides more than adequate visualization, as well as a dry environment, to make the arthroscopic application of BC significantly more efficient.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Kaiser Permanente, Baldwin Park, California, U.S.A.,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.,Address correspondence to Raffy Mirzayan, M.D., Department of Orthopaedic Surgery, Kaiser Permanente, 1011 Baldwin Park Blvd, Baldwin Park, CA 91706, U.S.A.
| | - Joseph D. Cooper
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Jorge Chahla
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, U.S.A
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de Windt TS, Vonk LA, Buskermolen JK, Visser J, Karperien M, Bleys RLAW, Dhert WJA, Saris DBF. Arthroscopic airbrush assisted cell implantation for cartilage repair in the knee: a controlled laboratory and human cadaveric study. Osteoarthritis Cartilage 2015; 23:143-50. [PMID: 25241243 DOI: 10.1016/j.joca.2014.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of arthroscopic airbrush assisted cartilage repair. METHODS An airbrush device (Baxter) was used to spray both human expanded osteoarthritic chondrocytes and choncrocytes with their pericellular matrix (chondrons) at 1 × 10(6) cells/ml fibrin glue (Tissucol, Baxter) in vitro. Depth-dependent cell viability was assessed for both methods with confocal microscopy. Constructs were cultured for 21 days to assess matrix production. A controlled human cadaveric study (n = 8) was performed to test the feasibility of the procedure in which defects were filled with either arthroscopic airbrushing or needle extrusion. All knees were subjected to 60 min of continuous passive motion and scored on outline attachment and defect filling. RESULTS Spraying both chondrocytes and chondrons in fibrin glue resulted in a homogenous cell distribution throughout the scaffold. No difference in viability or matrix production between application methods was found nor between chondrons and chondrocytes. The cadaveric study revealed that airbrushing was highly feasible, and that defect filling through needle extrusion was more difficult to perform based on fibrin glue adhesion and gravity-induced seepage. Defect outline and coverage scores were consistently higher for extrusion, albeit not statistically significant. CONCLUSION Both chondrons and chondrocytes can be evenly distributed in a sprayed fibrin glue scaffold without affecting viability while supporting matrix production. The airbrush technology is feasible, easier to perform than needle extrusion and allows for reproducible arthroscopic filling of cartilage defects.
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Affiliation(s)
- T S de Windt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - L A Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - J K Buskermolen
- Department of Developmental BioEngineering, University of Twente, Enschede, The Netherlands.
| | - J Visser
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M Karperien
- Department of Developmental BioEngineering, University of Twente, Enschede, The Netherlands.
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - W J A Dhert
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Veterinary Medicine, University of Utrecht, Utrecht, The Netherlands.
| | - D B F Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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