Kamimura Tamiko
Department of Orthopaedic Surgery, Tokorozawa Chuo Hospital, Tokorozawa, Japan.
Arthrosc Sports Med Rehabil. 2024 Mar 26;6(3):100932. doi: 10.1016/j.asmr.2024.100932. eCollection 2024 Jun.
To determine the optimal indocyanine green (ICG) dose required for assessing vascularity in the meniscus using ICG fluorescence-guided knee arthroscopy in a pig model.
A 3-month-old Japanese esculent female pig was used in this study. Intravenous injections of ICG (25 mg) were administered with 2.0 mL of 5×, 10×, 100×, and 1,000× diluted solutions. An additional experiment was conducted to assess the microvasculature within the meniscus considering the results of the optimal dilution setting. A radial tear was purposely induced in the middle-to-posterior section of the medial meniscus to observe vascularity in the cross-sectioned meniscus; the optimal ICG dilution was administered.
No fluorescence was detected in the meniscus with solutions diluted by 1,000× and 100×. Fluorescence was visualized at the anterior portion of the synovium and the anterior cruciate ligament using ICG diluted by 10×. Diluting ICG by 5×, contrast enhancement was too intense for observation. Therefore, the 10× diluted solution was considered the optimal setting for knee arthroscopy and observation of the radial tear. No fluorescence was observed in the cross section of the medial meniscus. Arterial hemorrhage was observed by stimulating the fluorescence-dyed synovium adjacent to the tear site. Through the additional waiting time after stimulating the tear site, the hemorrhage inside the meniscus became more intense.
The optimal dilution and dose setting of ICG for knee arthroscopy was 10× in a 2.0-mL intravenous injection. The meniscus showed no active blood flow, even in the red-red zone. This finding might support the notion that blood flow cannot be initiated, without synovial stimulation, even in vascular areas.
This study could determine an ICG solution suitable for ICG fluorescence-guided knee arthroscopy. This finding could be valuable in future research focusing on case-specific meniscal vascularization under arthroscopy, particularly applying these findings to human meniscal treatment.
在猪模型中，确定使用吲哚菁绿（ICG）荧光引导膝关节镜检查评估半月板血管时所需的最佳ICG剂量。
本研究使用一只3个月大的日本雌性家猪。静脉注射ICG（25mg），分别用2.0mL的5倍、10倍、100倍和1000倍稀释溶液。考虑到最佳稀释设置的结果，进行了一项额外实验以评估半月板内的微血管。在内侧半月板中后段故意制造一个放射状撕裂，以观察半月板横切面上的血管情况；给予最佳ICG稀释液。
用1000倍和100倍稀释的溶液在半月板中未检测到荧光。使用10倍稀释的ICG可在滑膜前部和前交叉韧带处看到荧光。用5倍稀释ICG时，对比度增强过度，无法进行观察。因此，10倍稀释溶液被认为是膝关节镜检查和观察放射状撕裂的最佳设置。在内侧半月板横切面上未观察到荧光。通过刺激撕裂部位附近的荧光染色滑膜观察到动脉出血。在刺激撕裂部位后延长等待时间，半月板内的出血变得更加明显。
膝关节镜检查的ICG最佳稀释度和剂量设置为静脉注射2.0mL的10倍稀释液。即使在红红区，半月板也未显示出活跃的血流。这一发现可能支持这样一种观点，即即使在血管区域，如果没有滑膜刺激，血流也无法启动。
本研究可以确定适合ICG荧光引导膝关节镜检查的ICG溶液。这一发现对于未来专注于关节镜下特定病例半月板血管化的研究可能具有重要价值，特别是将这些发现应用于人类半月板治疗。
