Purpose
This study was designed to evaluate differences in proinflammatory and degradative
mediator production and extracellular matrix degradation from osteoarthritic knee
articular cartilage and meniscus explants treated with either hyperosmolar saline
or isotonic saline.
Methods
6 mm-diameter full-thickness explants were created from articular cartilage and menisci
recovered after patients underwent knee surgery. One explant half was treated for
3 hours with hyperosmolar saline (600 mOsm/L) and the corresponding half with isotonic
saline (300 mOsm/L). Explants were subsequently cultured for 3 days in tissue culture
media. On day 3, media were collected for biomarker analyses. Results were normalized
to tissue wet weight and analyzed statistically.
Results
Articular cartilage was collected from 10 patients (5 male, 5 female; mean age = 66.9
years) and menisci were collected from 8 patients (2 male, 6 female; mean age = 66
years). Articular cartilage media concentrations of monocyte chemoattractant protein-1
(P = .001) and interleukin (IL)-6 (P = .049) were significantly lower in explants treated with hyperosmolar saline. Meniscus
media concentrations of prostaglandin E2 (P = .008), monocyte chemoattractant protein-1 (P = .011), IL-6 (P = .029), IL-8 (P = .012), matrix metalloproteinase-2 (P = .011), and glycosaminoglycan (P = .008) were significantly lower in explants treated with hyperosmolar saline.
Conclusions
Treatment of cartilage and meniscus explants with hyperosmolar saline effectively
mitigated key proinflammatory mediator production, as well as degradative mediator
production and glycosaminoglycan loss from meniscus, with no detrimental effects noted
compared to isotonic saline.
Clinical Relevance
These results suggest that hyperosmolar saline irrigation fluid may provide a safe
alternative to standard isotonic saline irrigation fluid, and could mitigate untoward
effects associated with inflammatory responses after standard-of-care knee arthroscopy.
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References
- On the viscosity and pH of synovial fluid and the pH of blood.J Bone Joint Surg Br. 1959; 41-B: 388-400
- The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review.J Orthop. 2019; 16: 158-165
- Arthroscopic irrigation of the bovine stifle joint increases cartilage surface friction and decreases superficial zone lubricin.J Biomech. 2016; 49: 3106-3110
- Osmolarity influences chondrocyte death in wounded articular cartilage.J Bone Joint Surg Am. 2008; 90: 1531-1542
- The osmotic sensitivity of isolated and in situ bovine articular chondrocytes.J Orthop Res. 2001; 19: 768-778
- Fluid extravasation in shoulder arthroscopic surgery: A systematic review.Orthop J Sports Med. 2018; 6 (2325967118771616)
- Safety and efficacy of hyperosmolar irrigation solution in shoulder arthroscopy.J Shoulder Elbow Surg. 2017; 26: 745-751
- Hyperosmolar irrigation compared with a standard solution in a canine shoulder arthroscopy model.J Shoulder Elbow Surg. 2015; 24: 1243-1248
- Intraarticular inflammatory cytokines in acute anterior cruciate ligament injured knee.Knee. 2003; 10: 93-96
- Acute and late changes in intraarticular cytokine levels following anterior cruciate ligament injury.J Orthop Res. 2013; 31: 315-321
- Characterization of synovial fluid cytokine profiles in chronic meniscal tear of the knee.J Orthop Res. 2017; 35: 340-346
- Matrix metalloproteinase activity and prostaglandin E2 are elevated in the synovial fluid of meniscus tear patients.Connect Tissue Res. 2017; 58: 305-316
- Early alteration of synovial membrane in osteoarthrosis.Clin Rheumatol. 1988; 7: 214-219
- Inflammatory mediators in osteoarthritis: A critical review of the state-of-the-art, current prospects, and future challenges.Bone. 2016; 85: 81-90
- Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!).Osteoarthritis Cartilage. 2013; 21: 16-21
- Surgical reconstruction of ruptured anterior cruciate ligament prolongs trauma-induced increase of inflammatory cytokines in synovial fluid: an exploratory analysis in the KANON trial.Osteoarthritis Cartilage. 2017; 25: 1443-1451
- Results of anterior cruciate ligament reconstruction with patellar tendon autografts: Objective factors associated with the development of osteoarthritis at 20 to 33 years after surgery.Am J Sports Med. 2017; 45: 2730-2738
- Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: Follow-up after two and ten years.Int Orthop. 2013; 37: 271-277
- Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: A 10-year prospective study on clinical results, knee osteoarthritis and its predictors.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 1977-1988
- The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population.Osteoarthritis Cartilage. 2018; 26: 195-201
- Knee osteoarthritis after arthroscopic partial meniscectomy: Prevalence and progression of radiographic changes after 5 to 12 years compared with contralateral knee.J Knee Surg. 2019; 32: 407-413
- Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: A prospective study with 10 to 15 years of follow-up.Am J Sports Med. 2010; 38: 2201-2210
- Synovial fluid profile at the time of anterior cruciate ligament reconstruction and its association with cartilage matrix composition 3 years after surgery.Am J Sports Med. 2018; 46: 890-899
- Temperature changes and chondrocyte death during drilling in a bovine cartilage model and chondroprotection by modified irrigation solutions.Int Orthop. 2014; 38: 2407-2412
- Hyperosmolarity protects chondrocytes from mechanical injury in human articular cartilage: An experimental report.J Bone Joint Surg Br. 2011; 93: 277-284
- The use of hyperosmotic saline for chondroprotection: Implications for orthopaedic surgery and cartilage repair.Osteoarthritis Cartilage. 2015; 23: 469-477
- Increasing the osmolarity of joint irrigation solutions may avoid injury to cartilage: A pilot study.Clin Orthop Relat Res. 2010; 468: 875-884
- Chondroprotection in models of cartilage injury by raising the temperature and osmolarity of irrigation solutions.Cartilage. 2018; 9: 313-320
- Room temperature versus warm irrigation fluid used for patients undergoing arthroscopic shoulder surgery: A systematic review and meta analysis.J Perianesth Nurs. 2020; 35: 48-53
- Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery.Arch Orthop Trauma Surg. 2015; 135: 1131-1139
- Metabolic responses of meniscus to IL-1beta.J Knee Surg. 2018; 31: 834-840
- Improved quantitation and discrimination of sulphated glycosaminoglycans by use of dimethylmethylene blue.Biochim Biophys Acta. 1986; 883: 173-177
- Inflammation in osteoarthritis.Curr Opin Rheumatol. 2011; 23: 471-478
- Dysregulated inflammatory response related to cartilage degradation after ACL injury.Med Sci Sports Exerc. 2020; 52: 535-541
- Identification of synovial fluid biomarkers for knee osteoarthritis and correlation with radiographic assessment.J Knee Surg. 2016; 29: 242-247
- The role of matrix metalloproteinases in osteoarthritis pathogenesis: An updated review.Life Sci. 2019; 234: 116786
- Joint fluid proteome after anterior cruciate ligament rupture reflects an acute posttraumatic inflammatory and chondrodegenerative state.Cartilage. 2020; 11: 329-337
- The joint synovium: A critical determinant of articular cartilage fate in inflammatory joint diseases.Semin Cell Dev Biol. 2017; 62: 86-93
- Changes in serum and synovial fluid biomarkers after acute injury (NCT00332254).Arthritis Res Ther. 2010; 12: R229
- Contributions of different intraarticular tissues to the acute phase elevation of synovial fluid MMP-2 following rat ACL rupture.J Orthop Res. 2009; 27: 243-248
- Coordinated expression of MMPs and TIMPs in rat knee intra-articular tissues after ACL injury.Connect Tissue Res. 2009; 50: 315-322
- Osmolarity influences chondrocyte repair after injury in human articular cartilage.J Orthop Surg Res. 2015; 10: 19
Article info
Publication history
Published online: July 18, 2020
Accepted:
July 12,
2020
Received:
January 23,
2020
See commentary on page 3058Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.M.S. reports personal fees and other from Arthrex, personal fees from Musculoskeletal Transplant Foundation, and other from DePuy Synthes, outside the submitted work. J.P.S. reports other from the American Orthopaedic Association, other from the AO Foundation, other from AO North America, grants and personal fees from Arthrex, grants from Coulter Foundation, personal fees from DePuy Synthes, other from Journal of Knee Surgery, other from Mid-America Orthopaedic Association, grants from National Institutes of Health (NIAMS & NICHD), personal fees from Orthopedic Designs North America, personal fees from Smith & Nephew, other from Thieme, and grants from U.S. Department of Defense, outside the submitted work. J.L.C. reports personal fees from Artelon, grants and personal fees from Arthrex, personal fees from AthleteIQ, grants from ConforMIS, personal fees from CONMED Linvatec, grants from the Coulter Foundation, grants from DePuy Synthes, grants and personal fees from Eli Lilly, other from Journal of Knee Surgery, grants from Merial, other from Midwest Transplant Network, grants, personal fees, and other from Musculoskeletal Transplant Network, grants from National Institutes of Health (NIAMS & NICHD), grants from Purina, personal fees from Schwartz Biomedical, personal fees and other from Thieme, personal fees from Trupanion, grants from U.S. Department of Defense, and grants from Zimmer-Biomet, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Raising the Osmolarity of Arthroscopic Irrigating Solutions May Be Chondroprotective: We Must Be Kind to Joints During Arthroscopy!ArthroscopyVol. 36Issue 12
- PreviewThe irrigation of joints during arthroscopic procedures typically uses a non-physiological solution. This replaces the natural synovial fluid and rapidly subjects the connective tissues to an alien hypo-osmotic environment in which cartilage cells are far more sensitive to iatrogenic injury. Raising the osmolarity of the irrigating solution may be a simple, safe, and effective chondroprotective strategy.
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