Fabio F A Ravaglia, Alberto Cliquet Jr
Purpose
It is common practice during arthroscopy to use a needle prior to a cutting knife to help target the correct entry point. This avoids damaging healthy structures and reduces healing time and scarring. However, once the knife itself is introduced, the risk of iatrogenic damage increases, potentially increasing the risk of post-operative complications like wound and joint infections, and ultimate cartilage damage. To develop a safer surgical instrument that is both cost-effective and environmentally-friendly, we designed and performed preliminary (pilot) testing on an Arthroscopic Needle-Knife Surgical Device (ANKSD) prototype.
Methods
An ANKSD prototype was developed using a 14-gauge 1.75-inch hypodermic needle, 10 cc syringe, and modeled handle. We then tested the device on 99 knees, using the ANKSD for the lateral portal and a standard knife for the medial portal; and compared the two sides in terms of time to suture removal, presence of discharge or incomplete healing, and post-operative complications. A preliminary assessment of cost savings was performed. Results: Overall, all but one of 198 portals healed well without discharge; that one portal had been created with the ANKSD, but the discharge resolved and wound healed on oral antibiotics taken at home within 6 days. No other complications resulted at either portal. A comparison of the two portals revealed no statistically-significant differences in outcomes, but use of the ANKSD was less time-consuming and cheaper, and had the additional advantage, relative to the standard blade, of allowing for both the injection and aspiration of fluids.
Conclusion
The prototype ANKSD we have developed, using a 14-gauge hypodermic needle attached to a 10 cc syringe, appears to be a safe, effective and cost-effective alternative to a standard surgical cutting knife during knee arthroscopy. Further in-vivo testing is warranted.
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