gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Use of laser angiography for intraoperative assessment of articular perfusion in patients with subchondral osteonecrosis

Meeting Abstract

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  • presenting/speaker Mark Mildren - University of Virginia, Charlottesville, United States
  • Quanjan Cui - University of Virginia, Charlottesville, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO30-808

doi: 10.3205/17dkou893, urn:nbn:de:0183-17dkou8934

Veröffentlicht: 23. Oktober 2017

© 2017 Mildren et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Laser angiography using indocyanine green has been described in the plastic and general surgery literature for a number of purposes including breast reconstruction, soft tissue rearrangement and bowel anastomosis. This procedure involves an intravenous injection of indocyanin green followed by visualization using an infrared camera of the area in question. To our knowledge, the use of indocyanine green and laser angiography for evaluation of articular cartilage in patients with osteonecrosis has not been described.

Methods: We present a series of 3 cases in which articular and subchondral perfusion was assessed intra-operatively. Our cases consist of an osteonecrosis of a talus, osteonecrosis of a medial femoral condyle and a slipped capital femoral epiphysis. All patients underwent surgical approach followed by visualization of the articular surface. In the case of talar osteonecrosis, following medial malleolar osteotomy, the dome of the talus and area of osteonecrosis was successfully imaged. The slipped capital femoral epiphysis was visualized before and after a Modified Dunn approach. The knee arthroplasty case was visualized using this similar technique following exposure and tourniquet deflation.

Results: All cases showed differential subchondral perfusion rates of varying degree. In the case of osteonecrosis of the talus, the area of interest was able to be delineated intra-operatively (Figure 1), leading to a more accurate surgical resection. In our patient with slipped capital femoral epiphysis, the articular surface was found to have perfusion immediately following reduction and fixation of the femoral head. The knee osteonecrosis case showed decreased fluorescence of the dye compared to surrounding areas, but the necrotic area was found to be sufficiently small enough to avoid a stemmed implant.

Conclusion: In this preliminary case series report, we were able to successfully document differential articular cartilage and subchondral perfusion by laser angiography. This is, to our knowledge, the first description of real time intra-operative assessment of the perfusion status of an articular surface with subchondral necrosis. Although this is a preliminary report, this technology may hold much promise in the diagnosis and treatment of pathology involving perfusion abnormalities of articular surfaces, including osteonecrosis, fracture, osteochondral defects and neoplasm.