Vascularisation Meniscus Study.sav

Background and purpose: The
healing capacity of the meniscus is directly related to blood supply. Therefore, high number of failure rates after
meniscal repair might be reduced by only suturing tears that are localised in
vascularised tissue. The aim of this study is to evaluate
the feasibility of Near Infrared Fluorescence (NIRF)-imaging using Indocyanine
Green (ICG) to visualise the vascularisation of the meniscus in patients
undergoing a total knee arthroplasty (TKA). We
determined the percentage of patients in which vascularisation in the menisci was
seen using NIRF-imaging, and correlated intraoperative findings to postoperative
immunohistochemistry of the meniscus.

Methods: In 10 patients,
the anterior part of the meniscus that was least affected by osteoarthritis was
removed during TKA to clearly visualize the inside of the meniscus. Next, 10 milligrams
of ICG was injected intravenously and vascularisation was imaged using the
Quest spectrum NIRF camera system. We calculated the percentage of patients where
vascularisation was seen intraoperatively using NIRF-imaging, as well as the
correlation between the extent of vascular ingrowth from the peripheral margin
towards the centre of the meniscus, as measured with NIRF-imaging and
immunohistochemistry.

Results: Meniscal vascularisation
using NIRF-imaging was seen in 75% of the patients in whom vascularisation was demonstrated
postoperatively with immunohistochemistry. The mean extent of vascular ingrowth
was 16% (standard deviation (SD) 14) using NIRF-imaging and 21% (SD 13) with
immunohistochemistry. A weak and non-significant correlation was estimated
between extent of vascular ingrowth measured between NIRF-imaging and
immunohistochemistry.

Conclusion: This study shows the
potential of NIRF-imaging to visualise the vascularisation of the meniscus
during meniscal surgery. However, further arthroscopic research is needed to
investigate this application for meniscal repair.