Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.
J Knee Surg. 2024 Jun;37(7):512-522. doi: 10.1055/a-2198-8131. Epub 2023 Oct 25.
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.
常用的等渗关节镜灌洗液，如生理盐水或乳酸林格氏液，最初是为静脉内给药而配制的，因此它们不能复制健康滑液的生理特性。滑液在调节关节内稳态方面起着重要作用，即使其成分和生理学的短暂中断也可能是有害的。先前的研究表明，高渗溶液可能是传统等渗液的一种有前途的替代物。本文旨在系统地回顾和综合以前发表的关于使用高渗关节镜灌洗液的基础科学、转化和临床研究，以确定用于临床的最佳灌洗液。根据系统评价和荟萃分析（PRISMA）指南，对 MEDLINE/PubMed 和 Embase 数据库进行了系统的文献检索。检索词为：（“软骨”和“高渗”）；（“关节镜”或“关节镜”和“高渗”）。筛选标题、摘要和全文，以获取关于高渗溶液和关节软骨的研究。评估了研究质量并收集了相关数据。由于研究异质性，未进行荟萃分析。对纳入的转化和临床研究进行了偏倚风险评估。本综述纳入了 10 项基础科学研究、2 项转化动物模型研究和 2 项临床研究。在基础科学研究中，有 7 项研究采用了机械损伤模型。转化研究在犬肩关节和马膝关节进行。临床研究在肩部和膝关节进行。多项基础科学、转化和临床研究强调了使用高渗溶液进行关节镜灌洗的短期安全性、成本效益和潜在益处。需要进一步的工作来开发和验证用于关节镜灌洗的理想高渗溶液配方，并为接受关节镜手术的患者带来长期益处。
