The effect of different continuous saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Chen , YANG Pu , ZHANG Dongfang , ZHANG Yi , SHEN Youliang , LI Haifeng , YU Tengbo ,  QI Chao

Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China;

Corresponding author：

QI Chao, Email: qichao2002@163.com

Keywords：

Knee arthroscopy; saline irrigation; meniscus plasty; knee pain; knee swelling

DOI：

10.7507/1002-1892.202006134

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Objective To investigate the effect of different saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee.Methods The clinical data of 539 patients with meniscus injury treated by arthroscopic menisci reformation who met the selection criteria between July 2016 and February 2020 were retrospectively analyzed. They were divided into three groups according to the continuous saline irrigation volume during the operation: 176 patients in the non-irrigation group (group A), 183 patients in the 1 liter-irrigation group (group B), and 180 patients in the 3 liters-irrigation group (group C). There was no significant difference in gender, age, cause of injury, sides of injury, body mass index, disease duration, smoking history, and classification of meniscus injury among 3 groups (P>0.05). At 6, 12, 24, 48, and 72 hours after operation, the patient’s pain level was evaluated by the visual analogue scale (VAS) score, and the knee swelling situation was evaluated by the swelling ratings (the difference between both sides in circumference of the 2 cm upper patella of the knee). Knee skin temperature (the difference of the skin temperature between both sides) and the C-reactive protein (CRP) level in serum were measured at the 1st and 3rd days after operation. Range of motion of the knee was measured at the 1st, 3rd, and 5th days after operation.Results All incisions healed by first intention without any complication after operation. The VAS scores of each group showed a slow increase trend after operation, and gradually decreased to less than the VAS score of 6 hours at 48 hours after operation. There was no significant difference in VAS scores among the 3 groups at each time point after operation (P>0.05). The swelling ratings of the knee in each group showed a gradually decrease trend after operation. There was no significant difference in the swelling ratings of the knee among the 3 groups at each time point after operation (P>0.05). The skin temperature of the knee in each group decreased at the 3rd day after operation than the 1st day, and there was no significant difference in the skin temperature of the knee among the 3 groups at each time point after operation (P>0.05). There was no significant difference in CRP level within the group and among the 3 groups at each time point after operation (P>0.05). Range of motion of the knee in each group increased gradually at the 1st, 3rd, and 5th days after operation, and there was no significant difference among the 3 groups at each time point after operation (P>0.05).Conclusion The different continuous saline irrigation volume would not affect the early postoperative pain, swelling, and inflammation of the knee during the arthroscopic menisci plasty.

Citation： WANG Chen, YANG Pu, ZHANG Dongfang, ZHANG Yi, SHEN Youliang, LI Haifeng, YU Tengbo, QI Chao. The effect of different continuous saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 178-182. doi: 10.7507/1002-1892.202006134 Copy

1.	Lind M, Lund B, Faunoe P, et al. The Impact of free or restricted rehabilitation after meniscus repair. A prospective randomized clinical trial. Arthroscopy, 2013, 29(10): e148.
2.	张凯搏, 毛贝尼, 张钟, 等. 中国膝关节镜手术相关并发症发生率的系统评价. 中国循证医学杂志, 2019, 19(12): 1400-1408.
3.	Yamasaki S, Hashimoto Y, Nishida Y, et al. Assessment of Meniscal Healing Status by Magnetic Resonance Imaging T2 Mapping After Meniscal Repair. Am J Sports Med, 2020, 48(4): 853-860.
4.	Imbert P, Schlatterer B. A risk-benefit analysis of alternating low-pressure CO₂ insufflation and fluid medium in arthroscopic knee ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2014, 22(7): 1483-1490.
5.	Yanmış I, Ozkan H, Koca K, et al. The relation between the arthroscopic findings and functional outcomes in patients with septic arthritis of the knee joint, treated with arthroscopic debridement and irrigation. Acta Orthop Traumatol Turc, 2011, 45(2): 94-99.
6.	Louise Fincher A, William Woods G, O’Connor DP. Intraoperative arthroscopic cold irrigation solution does not affect postoperative pain and swelling. J Athl Train, 2004, 39(1): 12-16.
7.	Olszewski AD, Jones R, Farrell R, et al. The effects of dilute epinephrine saline irrigation on the need for tourniquet use in routine arthroscopic knee surgery. Am J Sports Med, 1999, 27(3): 354-356.
8.	Yucens M, Aydemir AN. Trends in anterior cruciate ligament reconstruction in the last decade: A web-based analysis. J Knee Surg, 2019, 32(6): 519-524.
9.	Tuijthof GJ, Dusée L, Herder JL, et al. Behavior of arthroscopic irrigation systems. Knee Surg Sports Traumatol Arthrosc, 2005, 13(3): 238-246.
10.	Tuijthof GJ, de Vaal MM, Sierevelt IN, et al. Performance of arthroscopic irrigation systems assessed with automatic blood detection. Knee Surg Sports Traumatol Arthrosc, 2011, 19(11): 1948-1954.
11.	Jin Y, Tian J, Sun M, et al. A systematic review of randomised controlled trials of the effects of warmed irrigation fluid on core body temperature during endoscopic surgeries. J Clin Nurs, 2011, 20(3-4): 305-316.
12.	Gupta S, Manjuladevi M, Vasudeva Upadhyaya KS, et al. Effects of irrigation fluid in shoulder arthroscopy. Indian J Anaesth, 2016, 60(3): 194-198.
13.	Board TN, Srinivasan MS. The effect of irrigation fluid temperature on core body temperature in arthroscopic shoulder surgery. Arch Orthop Trauma Surg, 2008, 128(5): 531-533.
14.	Kelly JA, Doughty JK, Hasselbeck AN, et al. The effect of arthroscopic irrigation fluid warming on body temperature. J Perianesth Nurs, 2000, 15(4): 245-252.
15.	Hsiao MS, Kusnezov N, Sieg RN, et al. Use of an irrigation pump system in arthroscopic procedures. Orthopedics, 2016, 39(3): e474-478.
16.	Stärke F, Awiszus F, Lohmann CH, et al. The effect of irrigation time and type of irrigation fluid on cartilage surface friction. J Mech Behav Biomed Mater, 2018, 77: 187-191.

1. Lind M, Lund B, Faunoe P, et al. The Impact of free or restricted rehabilitation after meniscus repair. A prospective randomized clinical trial. Arthroscopy, 2013, 29(10): e148.
2. 张凯搏, 毛贝尼, 张钟, 等. 中国膝关节镜手术相关并发症发生率的系统评价. 中国循证医学杂志, 2019, 19(12): 1400-1408.
3. Yamasaki S, Hashimoto Y, Nishida Y, et al. Assessment of Meniscal Healing Status by Magnetic Resonance Imaging T2 Mapping After Meniscal Repair. Am J Sports Med, 2020, 48(4): 853-860.
4. Imbert P, Schlatterer B. A risk-benefit analysis of alternating low-pressure CO₂ insufflation and fluid medium in arthroscopic knee ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2014, 22(7): 1483-1490.
5. Yanmış I, Ozkan H, Koca K, et al. The relation between the arthroscopic findings and functional outcomes in patients with septic arthritis of the knee joint, treated with arthroscopic debridement and irrigation. Acta Orthop Traumatol Turc, 2011, 45(2): 94-99.
6. Louise Fincher A, William Woods G, O’Connor DP. Intraoperative arthroscopic cold irrigation solution does not affect postoperative pain and swelling. J Athl Train, 2004, 39(1): 12-16.
7. Olszewski AD, Jones R, Farrell R, et al. The effects of dilute epinephrine saline irrigation on the need for tourniquet use in routine arthroscopic knee surgery. Am J Sports Med, 1999, 27(3): 354-356.
8. Yucens M, Aydemir AN. Trends in anterior cruciate ligament reconstruction in the last decade: A web-based analysis. J Knee Surg, 2019, 32(6): 519-524.
9. Tuijthof GJ, Dusée L, Herder JL, et al. Behavior of arthroscopic irrigation systems. Knee Surg Sports Traumatol Arthrosc, 2005, 13(3): 238-246.
10. Tuijthof GJ, de Vaal MM, Sierevelt IN, et al. Performance of arthroscopic irrigation systems assessed with automatic blood detection. Knee Surg Sports Traumatol Arthrosc, 2011, 19(11): 1948-1954.
11. Jin Y, Tian J, Sun M, et al. A systematic review of randomised controlled trials of the effects of warmed irrigation fluid on core body temperature during endoscopic surgeries. J Clin Nurs, 2011, 20(3-4): 305-316.
12. Gupta S, Manjuladevi M, Vasudeva Upadhyaya KS, et al. Effects of irrigation fluid in shoulder arthroscopy. Indian J Anaesth, 2016, 60(3): 194-198.
13. Board TN, Srinivasan MS. The effect of irrigation fluid temperature on core body temperature in arthroscopic shoulder surgery. Arch Orthop Trauma Surg, 2008, 128(5): 531-533.
14. Kelly JA, Doughty JK, Hasselbeck AN, et al. The effect of arthroscopic irrigation fluid warming on body temperature. J Perianesth Nurs, 2000, 15(4): 245-252.
15. Hsiao MS, Kusnezov N, Sieg RN, et al. Use of an irrigation pump system in arthroscopic procedures. Orthopedics, 2016, 39(3): e474-478.
16. Stärke F, Awiszus F, Lohmann CH, et al. The effect of irrigation time and type of irrigation fluid on cartilage surface friction. J Mech Behav Biomed Mater, 2018, 77: 187-191.

Chinese Journal of Reparative and Reconstructive Surgery

The effect of different continuous saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee

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