Intra-operative assessment of the vascularisation of a cross section of the meniscus using near-infrared fluorescence imaging

Peter van Schie, Thies J N van der Lelij, Maxime Gerritsen, Ruben P J Meijer, Ewoud R A van Arkel, Marta Fiocco, Jan-Willem A Swen, Alexander L Vahrmeijer, Hans Marten Hazelbag, Stijn Keereweer, Pieter B A A van Driel, Peter van Schie, Thies J N van der Lelij, Maxime Gerritsen, Ruben P J Meijer, Ewoud R A van Arkel, Marta Fiocco, Jan-Willem A Swen, Alexander L Vahrmeijer, Hans Marten Hazelbag, Stijn Keereweer, Pieter B A A van Driel

Abstract

Purpose: The 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).

Methods: The 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.

Results: Meniscal 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.

Conclusion: This 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 evidence: IV.

Keywords: Indocyanine green; Intraoperative imaging; Meniscal vascularisation; Near-infrared fluorescence imaging; Total Knee Arthroplasty.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Schematic drawing of the human meniscus demonstrating the different vascular zone
Fig. 2
Fig. 2
Overview of the NIRF-imaging setup
Fig. 3
Fig. 3
Measurements on intra-operative images of the meniscus
Fig. 4
Fig. 4
Intra-operative imaging
Fig. 5
Fig. 5
Immunohistochemistry of the meniscus

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Source: PubMed

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