Intra-articular Pressure Changes during Stifle Arthroscopy Using a Cadaver Model

Abstract

Objective The aim of the study was to measure canine stifle intra-articular pressures (IAP) during arthroscopy using three different fluid pump pressure (FPP) settings.

Study Design Frozen thawed canine cadavers were used. The stifle was distended using a 2.7 mm arthroscope connected to a commercial fluid pump. Intra-articular pressure was measured using a portable pressure gauge connected to an intra-articular 18 G needle. Intra-articular pressure was recorded during stifle extension, 90 degrees flexion and full flexion at three different FPP (30, 50, 80 mm Hg).

Results Testing was performed on 27 stifles. Intra-articular pressure significantly increased at higher FPP (p < 0.01). At FPP 30, 50, and 80 mm Hg, the mean IAP was 51.8 (95% confidence interval [CI]: 41.3–62.2), 103.3 (95% CI: 92.8–113.7), and 175.2 mm Hg (95% CI: 164.8–185.6), respectively. At FPP 30 and 50 mm Hg, IAP always remained under 170 mm Hg. At 80 mm Hg, IAP raised to or above 170 mm Hg in 11/14 stifles. Stifle position significantly affected IAP (p < 0.01). Changing stifle position from 90 degrees flexion to extension significantly decreased IAP by 22.4 mm Hg (95% CI: 16.2–28.5), and changing to full flexion significantly increased IAP by 20.9 mm Hg (95% CI: 14.8–27.1; p < 0.01).

Conclusion Our results suggest that caution should be used during stifle arthroscopy to limit risk for iatrogenic capsular damage. Fluid pump pressure 30 mm Hg is considered safe when using a 2.7 mm arthroscope and high flow cannula. If higher FPP is necessary for visualization, duration of stifle flexion should be limited. Fluid pump pressure 80 mm Hg should be avoided.

Keywords

joint surgery - orthopaedic surgery - stifle joint - cranial cruciate - ligament injury - dog

Publikationsverlauf

Eingereicht: 25. Oktober 2022

Angenommen: 23. Juni 2023

Artikel online veröffentlicht:
11. August 2023

• References

• 1 Wilke VL, Robinson DA, Evans RB, Rothschild MF, Conzemius MG. Estimate of the annual economic impact of treatment of cranial cruciate ligament injury in dogs in the United States. J Am Vet Med Assoc 2005; 227 (10) 1604-1607
• 2 Pozzi A, Hildreth III BE, Rajala-Schultz PJ. Comparison of arthroscopy and arthrotomy for diagnosis of medial meniscal pathology: an ex vivo study. Vet Surg 2008; 37 (08) 749-755
• 3 Hoelzler MG, Millis DL, Francis DA, Weigel JP. Results of arthroscopic versus open arthrotomy for surgical management of cranial cruciate ligament deficiency in dogs. Vet Surg 2004; 33 (02) 146-153
• 4 Thieman KM, Tomlinson JL, Fox DB, Cook C, Cook JL. Effect of meniscal release on rate of subsequent meniscal tears and owner-assessed outcome in dogs with cruciate disease treated with tibial plateau leveling osteotomy. Vet Surg 2006; 35 (08) 705-710
• 5 Nade S, Newbold PJ. Factors determining the level and changes in intra-articular pressure in the knee joint of the dog. J Physiol 1983; 338: 21-36
• 6 Phelps P, McCarty Jr DJ. Crystal-induced inflammation in canine joints. II. Importance of polymorphonuclear leukocytes. J Exp Med 1966; 124 (01) 115-126
• 7 Mayo M, Wolsky R, Baldini T, Vezeridis PS, Bravman JT. Gravity fluid flow more accurately reflects joint fluid pressure compared with commercial peristaltic pump systems in a cadaveric model. Arthroscopy 2018; 34 (12) 3132-3138
• 8 Sperber A, Wredmark T. Tensile properties of the knee-joint capsule at an elevated intraarticular pressure. Acta Orthop Scand 1998; 69 (05) 484-488
• 9 Nade S, Newbold PJ. Pressure-volume relationships and elastance in the knee joint of the dog. J Physiol 1984; 357: 417-439
• 10 Galvin JW, Ernat JJ, Grippo RJ, Li X, Parada SA, Eichinger JK. Analysis of glenohumeral joint intraarticular pressure measurements in volume-limited MR arthrograms in patients with shoulder-instability compared to a control group. J Orthop 2019; 17: 63-68
• 11 Taha ME, Schneider K, Smith MM, Cunningham G, Young AA, Cass B. Accuracy of arthroscopic fluid pump systems in shoulder surgery: a comparison of 3 different pump systems. J Shoulder Elbow Surg 2020; 29 (12) 2626-2631
• 12 Muellner T, Menth-Chiari WA, Reihsner R, Eberhardsteiner J, Engebretsen L. Accuracy of pressure and flow capacities of four arthroscopic fluid management systems. Arthroscopy 2001; 17 (07) 760-764
• 13 Ross JA, Marland JD, Payne B, Whiting DR, West HS. Do arthroscopic fluid pumps display true surgical site pressure during hip arthroscopy. Arthroscopy 2018; 34 (01) 126-132
• 14 da Gracca Macoris D, Bertone A. Intra-articular pressure profiles of the cadaveric equine fetlock joint in motion. Equine Vet J 2001; 33 (02) 184-190