Blood Flow in the Meniscus Can Be Visualized Arthroscopically Using an Intravenous Indocyanine Green Solution Diluted 10× in a Pig Model

Abstract

Purpose

To determine the optimal indocyanine green (ICG) dose required for assessing vascularity in the meniscus using ICG fluorescence-guided knee arthroscopy in a pig model.

Methods

A 3-month-old Japanese esculent female pig was used in this study. Intravenous injections of ICG (25 mg) were administered with 2.0 mL of 5×, 10×, 100×, and 1,000× diluted solutions. An additional experiment was conducted to assess the microvasculature within the meniscus considering the results of the optimal dilution setting. A radial tear was purposely induced in the middle-to-posterior section of the medial meniscus to observe vascularity in the cross-sectioned meniscus; the optimal ICG dilution was administered.

Results

No fluorescence was detected in the meniscus with solutions diluted by 1,000× and 100×. Fluorescence was visualized at the anterior portion of the synovium and the anterior cruciate ligament using ICG diluted by 10×. Diluting ICG by 5×, contrast enhancement was too intense for observation. Therefore, the 10× diluted solution was considered the optimal setting for knee arthroscopy and observation of the radial tear. No fluorescence was observed in the cross section of the medial meniscus. Arterial hemorrhage was observed by stimulating the fluorescence-dyed synovium adjacent to the tear site. Through the additional waiting time after stimulating the tear site, the hemorrhage inside the meniscus became more intense.

Conclusions

The optimal dilution and dose setting of ICG for knee arthroscopy was 10× in a 2.0-mL intravenous injection. The meniscus showed no active blood flow, even in the red-red zone. This finding might support the notion that blood flow cannot be initiated, without synovial stimulation, even in vascular areas.

Clinical Relevance

This study could determine an ICG solution suitable for ICG fluorescence-guided knee arthroscopy. This finding could be valuable in future research focusing on case-specific meniscal vascularization under arthroscopy, particularly applying these findings to human meniscal treatment.