Abstract
PurposeThe purpose of this study was to assess whether the vascularisation of the meniscus could be visualised intra-operatively using near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) in patients undergoing total knee arthroplasty (TKA).MethodsThe anterior horn (i.e., Cooper classification: zones C and D) of the meniscus that was least affected (i.e., least degenerative) was removed during TKA surgery in ten patients to obtain a cross section of the inside of the meniscus. Thereafter, 10 mg of ICG was injected intravenously, and vascularisation of the cross section of the meniscus was assessed using the Quest spectrum NIRF camera system. We calculated the percentage of patients in whom vascularisation was observed intra-operatively using NIRF imaging compared to immunohistochemistry.ResultsMeniscal vascularisation using NIRF imaging was observed in six out of eight (75%) patients in whom vascularisation was demonstrated with immunohistochemistry. The median extent of vascularisation was 13% (interquartile range (IQR) 3–28%) using NIRF imaging and 15% (IQR 11–23%) using immunohistochemistry.ConclusionThis study shows the potential of NIRF imaging to visualise vascularisation of the meniscus, as vascularisation was observed in six out of eight patients with histologically proven meniscal vascularisation.Level of evidenceIV.
Highlights
Traumatic ruptures mostly occur in young and athletic people with non-degenerative meniscal tissue who benefit from surgical repair [10]
In the remaining eight patients, vascularisation was observed in six patients using near-infrared fluorescence (NIRF) imaging
The median extent of meniscal vascularisation measured with NIRF imaging was 13% (interquartile range (IQR) 3–28%)
Summary
Traumatic ruptures mostly occur in young and athletic people with non-degenerative meniscal tissue who benefit from surgical repair [10]. The success rate can be improved by repairing only meniscal tears that are located in vascularised tissue, as the healing capacity of the meniscus is directly related to the blood supply [2, 22]. The outermost or peripheral zone, which is penetrated by vessels from the peri-meniscal plexus, is known as the vascularised red–red zone or zone 1. Zone 2 is located between the red–red and white–white zones and is known as the transition zone or red–white zone, where blood vessels may occasionally be present. Large variation among individuals in the extent of vascularisation has been reported, making it difficult to assess pre- and intra-operatively whether a tear is located in vascularised tissue [2, 7]
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