Blind versus arthroscopic application of a novel system for synovial biopsy

Abstract

BackgroundSynovial biopsies are commonly performed arthroscopically under full or regional anaesthesia. Indications for synovial biopsies are miscellaneous, including suspected metabolic, inflammatory, infective or neoplastic pathologies. Some of them can mimick overuse or protracted sport injuries.This study aimed to surgical technically compare retrograde synovial biopsy in combination with arthroscopy or in a non-arthroscopic approach. Materials and MethodsThe retrograde forceps (Retroforce, KARL STORZ GmbH, Tuttlingen, Germany) used for this technique consists of a semi-blunt trochar and a modified reverse flap at its distal end. Under local anesthesia, intra-articular position of the instrument is confirmed by aspiration via a fluid channel. For arthroscopy synovial tissue is directly visualized and the forceps inserted according to the site of highest macroscopic inflammation. ResultsUsing the retrograde forceps, we have obtained synovial biopsies of the knee joint in 12 patients. Of those, six interventions were performed during arthroscopy and six under local anesthesia. Representative material was obtained in all 12 patients and synovial tissue was confirmed by a pathologist in all cases. No bleeding or infection occurred after the intervention. ConclusionsRetrograde synovial biopsy is a novel procedure to obtain rapidly synovial tissue both during arthroscopy, and less invasively, under local anaesthesia. Level of evidenceLevel II (surgical technical comparative study).