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Meniscus repair: A pathologic study
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ABSTRACTS
necrosis and allows almost pure laser vaporization; and (c) no evidence of lymphangitis or lymphadenopathy secondary to carbon particles (as noted by Dr. Terry Whipple) has been noted with the pulsed laser technique.
Intraarticular Pressures During Arthroscopic Knee Surgery. Harold B. Kitaoka, John W. Ewing, Donald Noe, and Michael Askew. Akron, Ohio, U.S.A. Arthroscopic surgery of the knee requires effective saline distention to provide adequate visualization. Despite known complications related to joint overdistention and a myriad of available fluid delivery systems, no reports exist in the literature relating to optimal fluid pressures and dynamics. Static and dynamic laboratory studies were performed upon a knee model to establish an accurate method of measuring pressures from the arthroscopic cannula. A prospective study of 107 subjects who underwent arthroscopy by one surgeon was then performed using pressurized saline. A sterile, fluid-filled tubing from the arthroscope cannula led to a bladder transducer tube, transducer unit, and ultimately, a strip chart recorder. Intraarticular pressures ranged from 0 to 750 mm Hg and usually fell into the zone of approximately 100 mm Hg. A minimum pressure of 30 mm Hg was required for visualization. Factors affecting pressure magnitudes as well as flow rates were studied. Technical suggestions based upon these data include (a) maintenance of pressure between 70 and 120 mg Hg to allow clear observation without excessive extra synovial fluid dissection; (b) abrupt changes in position of the distended knee should be avoided (this is especially important when manipulating a closed distended knee in which a separate inflow or outflow portal is not patent, as pressures up to 750 mm Hg may be generated); (c) if the synovium is violated (e.g., lateral release procedure), pressure levels must be limited and a greater flow rate applied; and (d) a pressurized fluid delivery system enhances the performance of arthroscopic procedures by affording excellent visualization without remarkable adverse effects. These data have been utilized toward the development of a low-pressure, demand volume, automated inflow fluid delivery system that can be used for arthroscopic surgery of the knee. The pump system has been used clinically in over 50 cases of knee arthroscopic surgery without complications, Arthroscopy, Vol. 2, No. 2, 1986
and the mechanisms include an air-detection safety system, an electrically and nonelectrically controlled pressure warning system to avoid excessive pressures, and a controlled suction outflow automated system.
Meniscus Repair: A Pathologic Study. Lanny L. Johnson, Robert W. Bell, David A. Detrisac, and Gretchen L. Flo. East Lansing, Michigan, U.S.A. The purpose of the study was to determine the nature of meniscal tissue repair and cellular source. The study had two dimensions: laboratory and clinical. The laboratory study took human meniscus obtained at arthroscopic meniscectomy. The meniscus was cut in squares, and a 2-ram core was placed through section. The sterile sections were placed in separate Petri dishes. The sections were covered with saline, patient's plasma, patient's synovial fluid, patient's whole blood, and a synovial fluid blood mixture. The sections were placed in organ culture for 6 weeks, then subjected to gross and microscopic inspection. There was no cellular contribution from meniscus tissue. Neither saline, patient's plasma, nor synovial fluid produced any cellular repair. Only blood or the blood-synovial fluid mixture showed gross clot and fibroblastic cellular repair. The second part of the study involved selective biopsies of meniscal repairs and free meniscal autografts between 10 weeks and 6 months postoperatively in patients between 20 and 65 years of age. The pathologic studies showed meniscal tissue to heal in an envelope of articular fibrous tissue, presumably of whole blood origin. There was vascular proliferation near the synovial wall but no evidence of penetration of vessels into repaired or grafted meniscus. There Was no integration of repaired meniscus to meniscus or capsule by collagen or fibrosis or angioblastic proliferation. Whole blood is necessary for repair of meniscal tissue. Vascularity in the form of angioblastic contribution is not essential for meniscal repair. Age is not a deterrent to meniscal repair. The significance rests in avoiding operative indications and techniques based on misconceptions of the importance of vascular angioblastic activity in meniscal healing.
The Role of Arthroscopy in the Treatment of Postoperative Fibroarthrosis of the Knee Joint. J. Serge Parisien. New York, New York, U.S.A.
ABSTRACTS
necrosis and allows almost pure laser vaporization; and (c) no evidence of lymphangitis or lymphadenopathy secondary to carbon particles (as noted by Dr. Terry Whipple) has been noted with the pulsed laser technique.
Intraarticular Pressures During Arthroscopic Knee Surgery. Harold B. Kitaoka, John W. Ewing, Donald Noe, and Michael Askew. Akron, Ohio, U.S.A. Arthroscopic surgery of the knee requires effective saline distention to provide adequate visualization. Despite known complications related to joint overdistention and a myriad of available fluid delivery systems, no reports exist in the literature relating to optimal fluid pressures and dynamics. Static and dynamic laboratory studies were performed upon a knee model to establish an accurate method of measuring pressures from the arthroscopic cannula. A prospective study of 107 subjects who underwent arthroscopy by one surgeon was then performed using pressurized saline. A sterile, fluid-filled tubing from the arthroscope cannula led to a bladder transducer tube, transducer unit, and ultimately, a strip chart recorder. Intraarticular pressures ranged from 0 to 750 mm Hg and usually fell into the zone of approximately 100 mm Hg. A minimum pressure of 30 mm Hg was required for visualization. Factors affecting pressure magnitudes as well as flow rates were studied. Technical suggestions based upon these data include (a) maintenance of pressure between 70 and 120 mg Hg to allow clear observation without excessive extra synovial fluid dissection; (b) abrupt changes in position of the distended knee should be avoided (this is especially important when manipulating a closed distended knee in which a separate inflow or outflow portal is not patent, as pressures up to 750 mm Hg may be generated); (c) if the synovium is violated (e.g., lateral release procedure), pressure levels must be limited and a greater flow rate applied; and (d) a pressurized fluid delivery system enhances the performance of arthroscopic procedures by affording excellent visualization without remarkable adverse effects. These data have been utilized toward the development of a low-pressure, demand volume, automated inflow fluid delivery system that can be used for arthroscopic surgery of the knee. The pump system has been used clinically in over 50 cases of knee arthroscopic surgery without complications, Arthroscopy, Vol. 2, No. 2, 1986
and the mechanisms include an air-detection safety system, an electrically and nonelectrically controlled pressure warning system to avoid excessive pressures, and a controlled suction outflow automated system.
Meniscus Repair: A Pathologic Study. Lanny L. Johnson, Robert W. Bell, David A. Detrisac, and Gretchen L. Flo. East Lansing, Michigan, U.S.A. The purpose of the study was to determine the nature of meniscal tissue repair and cellular source. The study had two dimensions: laboratory and clinical. The laboratory study took human meniscus obtained at arthroscopic meniscectomy. The meniscus was cut in squares, and a 2-ram core was placed through section. The sterile sections were placed in separate Petri dishes. The sections were covered with saline, patient's plasma, patient's synovial fluid, patient's whole blood, and a synovial fluid blood mixture. The sections were placed in organ culture for 6 weeks, then subjected to gross and microscopic inspection. There was no cellular contribution from meniscus tissue. Neither saline, patient's plasma, nor synovial fluid produced any cellular repair. Only blood or the blood-synovial fluid mixture showed gross clot and fibroblastic cellular repair. The second part of the study involved selective biopsies of meniscal repairs and free meniscal autografts between 10 weeks and 6 months postoperatively in patients between 20 and 65 years of age. The pathologic studies showed meniscal tissue to heal in an envelope of articular fibrous tissue, presumably of whole blood origin. There was vascular proliferation near the synovial wall but no evidence of penetration of vessels into repaired or grafted meniscus. There Was no integration of repaired meniscus to meniscus or capsule by collagen or fibrosis or angioblastic proliferation. Whole blood is necessary for repair of meniscal tissue. Vascularity in the form of angioblastic contribution is not essential for meniscal repair. Age is not a deterrent to meniscal repair. The significance rests in avoiding operative indications and techniques based on misconceptions of the importance of vascular angioblastic activity in meniscal healing.
The Role of Arthroscopy in the Treatment of Postoperative Fibroarthrosis of the Knee Joint. J. Serge Parisien. New York, New York, U.S.A.