Effects of Viscoseal, a synovial fluid substitute, on recovery after arthroscopic partial meniscectomy and joint lavage.
This was a pilot, single blind, randomised, controlled study in patients requiring partial meniscectomy. The aim was to assess whether replacing the synovial fluid lost during arthroscopy with a hyaluronic acid-containing synovial fluid substitute (Viscoseal) would reduce the severity and duration of post-operative symptoms during the 4 weeks post-surgery, in comparison to the standard arthroscopy procedure alone. Fifty patients were randomly assigned to either undergo arthroscopic partial meniscectomy alone (control group: n=25) or to receive 10 ml Viscoseal into the joint at the end of the procedure (Viscoseal group: n=25). Forty patients (20 per group) completed the study. Despite the small patient population in this pilot study, some interesting results were obtained. On Day 1 after surgery, the mean values for pain at rest (VAS) increased in both groups but this increase was lower in the Viscoseal group (8.9+/-23.1 mm) than in the standard therapy group (20.0+/-25.9 mm) (Mann-Whitney statistic MW-S: P=0.0525) and remained in favour of Viscoseal for the first 3 days after surgery. Joint swelling decreased to a greater extent in the Viscoseal group with an observed superiority at Day 7 (MW-S: P=0.1187) and a proven superiority at Days 12 (MW-S: P=0.015) and 28 (MW-S: P=0.0072). Diclofenac intake was lower in the Viscoseal group from Day 3 to Day 28 with a proven superiority (LB-CI > 0.5) in favour of Viscoseal on Days 3 (MW-S: P = 0.0093), 4 (MW-S: P= 0.0075), and 7 (MW-S: P = 0.0195) indicating that the product had an NSAID-sparing effect. Viscoseal was safe and well-tolerated and no adverse reactions occurred during the study. These findings indicate that Viscoseal may be useful as a synovial fluid substitute after arthroscopy.
Mathies
B
B
Department of Knee Surgery, Hôpital de La Tour, Av. J.-D. Maillard 3, 1217, Meyrin, Geneva, Switzerland. burkhard.mathies@latour.ch
D000203:Activities of Daily Living; D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001182:Arthroscopy; D004008:Diclofenac / Q000627:therapeutic use; D004487:Edema / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010865:Pilot Projects; D020127:Recovery of Function; D016037:Single-Blind Method; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; D000894:Anti-Inflammatory Agents, Non-Steroidal; C509830:Viscoseal; D004008:Diclofenac; D006820:Hyaluronic Acid