Abstract
Commonly used isotonic arthroscopic irrigation fluids, such as normal saline or lactated
Ringer's, were initially formulated for intravenous administration so they do not
replicate the physiologic properties of healthy synovial fluid. Synovial fluid plays
an important role in regulating joint homeostasis such that even transient disruptions
in its composition and physiology can be detrimental. Previous studies suggest that
hyperosmolar solutions may be a promising alternative to traditional isotonic fluids.
This manuscript sought to systematically review and synthesize previously published
basic science, translational, and clinical studies on the use of hyperosmolar arthroscopic
irrigation fluids to delineate the optimal fluid for clinical use. A systematic literature
search of MEDLINE/PubMed and Embase databases was performed in accordance with Preferred
Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. The search
phrases were: (“cartilage” AND “hyperosmolar”); (“arthroscopy” OR “arthroscopic” AND
“hyperosmolar”). The titles, abstracts, and full texts were screened for studies on
hyperosmolar solutions and articular cartilage. Study quality was assessed, and relevant
data were collected. A meta-analysis was not performed due to study heterogeneity.
A risk of bias assessment was performed on the included translational and clinical
studies. There were 10 basic science studies, 2 studies performed in translational
animal models, and 2 clinical studies included in this review. Of the basic science
studies, 7 utilized a mechanical injury model. The translational studies were carried
out in the canine shoulder and equine stifle (knee) joint. Clinical studies were performed
in the shoulder and knee. Multiple basic science, translational, and clinical studies
highlight the short-term safety, cost-effectiveness, and potential benefits associated
with use of hyperosmolar solutions for arthroscopic irrigation. Further work is needed
to develop and validate the ideal formulation for a hyperosmolar irrigation solution
with proven long-term benefits for patients undergoing arthroscopic surgeries.
Keywords
hyperosmolar - arthroscopic surgery - cartilage - systematic review
