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Epithelial tissue cut‐out following needle insertion into a joint: a potential complication during arthroscopy
Author(s) -
Epstein Daniel J.,
McCullough Keith
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15131
Subject(s) - medicine , epithelial tissue , hypodermic needle , arthroscopy , ex vivo , anatomy , epithelium , soft tissue , lumen (anatomy) , septic arthritis , surgery , in vivo , pathology , arthritis , biology , microbiology and biotechnology , psychiatry , immunology , syringe
Background Knee arthroscopy is a common orthopaedic procedure and often involves insertion of a needle through skin into a joint. This needle insertion can create epithelial tissue cut‐outs possibly containing commensal bacteria that can be flushed into the joint, and potentially lead to post‐arthroscopy septic arthritis. This study aims to assess the frequency of epithelial tissue cut‐out creation on insertion of different needle sizes at different angles to the skin. Methods Using an ex‐vivo porcine limb tissue model, needles of various gauge (14–23G) were inserted at angles of 90, 60, 45 and 30° to the skin surface. Ten passes were undertaken at each angle. Needle lumen contents were then examined for solid tissue cut‐out. Results Two hundred and eighty needle passes were performed resulting in 70 tissue cut‐outs (25%) containing solid material. This was more common amongst lower gauge needles. 8 of the 70 (11.4%) tissue cut‐outs contained macroscopic evidence of epithelium. The overall rate of epithelial tissue cut‐out was 2.9%. The 23G needle had the lowest rate of tissue cut‐out creation, occurring twice out of 40 passes ( P = 0.002). Neither of these contained macroscopic epithelial tissue. Conclusion Hypodermic needle insertion through skin into a joint can create epithelial tissue cut‐out. Epithelial tissue cut‐out occurs more frequently with use of lower gauge needles. This study suggests use of a 23G needle during arthroscopy, inserted either at 60 or 90° to the skin, to reduce epithelial tissue cut‐out and any potential contribution to post‐arthroscopy septic arthritis.