The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review
Bibliographic record
Abstract
PURPOSE: Arthroscopic surgery has become an important and popular orthopedic procedure for numerous joint disorders. Continuous irrigation is performed to replace synovial fluid for optimal joint distension and clear visualization of the synovial cavity. Irrigation solutions may, however, negatively impact articular cartilage and chondrocyte viability. This systematic review aims to compare different irrigating solutions and their properties to determine whether one is superior in its effects on articular cartilage and chondrocytes. METHODS: A systematic literature review was conducted. The online databases: Embase, Medline, HealthStar, Emcare and PubMed were searched from 1946 to August 2018. Methodological index for non-randomized studies (MINORS) was used to assess methodological quality of the included studies. RESULTS: Sixteen studies met the inclusion/exclusion criteria and were included in this review. Although the studies used different criteria to define superiority, solution superiority was based on results that focused on articular cartilage and chondrocyte viability. Seven of the sixteen included studies compared Ringer's/lactate solution or Ringer's lactate to normal saline. Three found Ringer's solution or Ringer's lactate to be superior to saline, whereas, three studies found no significant differences and one study found Ringer's lactate to be inferior to saline only when their osmolarities differed. Four studies compared ionic to non-ionic solutions. Two of the four studies demonstrated non-ionic solutions to be superior, one had demonstrated no significant differences between solutions, while one had mixed results. Six of the sixteen included studies compared differing osmolarities. One found no statistically significant differences between solutions of differing osmolarities, whereas, the remaining five studies found superiority with hyperosmolarity. Two of the sixteen included studies examined the effects of different temperatures. Both studies concluded that the use of a warmer (more physiological) temperature is more ideal. Two of the sixteen studies included in this review compared solutions with differing pH levels. Both studies concluded on the importance of utilizing the more physiological solutions for arthroscopic procedures. CONCLUSION: Ringer's Lactate and Ringer's Solution as well as non-ionic solutions may have merit over the use of the normal saline for irrigation. Hyperosmolarity, warmer solutions and ones with more physiological pH values may be beneficial when considering potential effects on articular cartilage and chondrocytes. The current review demonstrated trends found in the current literature, which require human studies - preferably high quality RCTs -to make recommendations that aid surgeons in making the best decision regarding the ideal irrigation solution to use on their patients. LEVEL OF EVIDENCE: Level IV, Systematic review of Level IV studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.010 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".