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| Name | Class |
|---|---|
| Arthrex, Inc. | INDUSTRY |
| Diagnostic Green GmbH | INDUSTRY |
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This trial is an explorative single center, single-arm study to assess whether vascularization of the meniscus can be visualized intraoperatively using arthroscopic near-infrared (NIR) fluorescence using ICG during standard of care meniscal repair treatment.
The meniscal healing process is based on two fundamental principles: a solid primary fixation, and a well-functioning biological process of cicatrization, where the presence of vascularization is thought to play a major role. Intra-operative near infrared fluorescence angiography using Indocyanine Green (ICG) is a widely used method for operative assessment of vascularization. Fluorescence guided detection of the vascularity surrounding a meniscal tear could be of great value to predict meniscal healing after repair.
This pilot study will explore the technical feasibility of intraoperative near-infrared fluorescence angiography of the meniscus in patients undergoing arthroscopic meniscal repair. Technical challenges for NIR fluorescence arthroscopy are the visibility of the vascular perfusion in microvessels in the dense meniscus, motion artifacts encountered with arthroscopy and wash in of ICG using a fluid irrigation system.
The included patients will be subdivided in four equal subgroups in order to evaluate alteration of NIR fluorescence signal during arthroscopy in combination with a tourniquet and/or irrigation pump system.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NIR fluorescence | Experimental | The included patients will be subdivided in four equal subgroups in order to evaluate alteration of NIR fluorescence signal during arthroscopy in combination with a (temporary) tourniquet and irrigation pump system. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NIR fluorescence imaging of the vascular perfusion of the meniscus using ICG | Procedure | NIR fluorescence imaging of vascular perfusion using the Arthrex NIR fluorescence scope and Indocyanin Green |
| Measure | Description | Time Frame |
|---|---|---|
| NIR fluorescence of the meniscus | Detection of fluorescence in the meniscus (yes/no), determined intra-operatively during the arthroscopy procedure using NIR fluorescence imaging and ICG. | Fluorescence imaging will be performed from 0-10 minutes after injection of ICG |
| Measure | Description | Time Frame |
|---|---|---|
| T start | Time between injection of ICG and initial detection of the fluorescence signal in the meniscus (T start). | Fluorescence imaging will be performed from 0-10 minutes after injection of ICG |
| I max |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Pieter B.A.A. van Driel, MD, PhD | Contact | 003188 6245000 | p.b.a.a.van.driel@isala.nl |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23881033 | Result | Vahrmeijer AL, Hutteman M, van der Vorst JR, van de Velde CJ, Frangioni JV. Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol. 2013 Sep;10(9):507-18. doi: 10.1038/nrclinonc.2013.123. Epub 2013 Jul 23. | |
| 34064948 | Result | Goncalves LN, van den Hoven P, van Schaik J, Leeuwenburgh L, Hendricks CHF, Verduijn PS, van der Bogt KEA, van Rijswijk CSP, Schepers A, Vahrmeijer AL, Hamming JF, van der Vorst JR. Perfusion Parameters in Near-Infrared Fluorescence Imaging with Indocyanine Green: A Systematic Review of the Literature. Life (Basel). 2021 May 11;11(5):433. doi: 10.3390/life11050433. |
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Maximum fluorescence intensity (Imax) in the meniscus. Fluorescence intensity will be measured in arbitrary units as a mean of three different region of interests.
| Fluorescence imaging will be performed from 0-10 minutes after injection of ICG |
| T max | Time to maximum intensity of the fluorescence signal | 0-10 minutes |
| Baseline and End fluorescence intensity | Baseline fluorescence intensity of the meniscus and the end fluorescence intensity in the meniscus | Fluorescence imaging will be performed from 0-10 minutes after injection of ICG |
| The ration between the maximum fluorescence intensity in the meniscus and the background fluorecence intensity. | The fluorescence intensity is measured in arbitrary units as a mean of three region of interests. | Fluorescence imaging will be performed from 0-10 minutes after injection of ICG |
| 34347140 | Result | van Schie P, van der Lelij TJN, Gerritsen M, Meijer RPJ, van Arkel ERA, Fiocco M, Swen JA, Vahrmeijer AL, Hazelbag HM, Keereweer S, van Driel PBAA. Intra-operative assessment of the vascularisation of a cross section of the meniscus using near-infrared fluorescence imaging. Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1629-1638. doi: 10.1007/s00167-021-06690-w. Epub 2021 Aug 4. |