Advances in the Canine Cranial Cruciate Ligament, 2nd edition

186 Surgical Treatment

Control group

Treatment group

Control group

Treatment group

Lavage at Week 1 Lavage at Week 2 Lavage at Week 3

*

(A) 6

(B)

4 4 3 2 1 0

2

0

Histologic scale

Histologic scale

*

*

*

*

*

Cartilage

Synovium

Lavage at Week 1 Lavage at Week 2 Lavage at Week 3

Figure 24.1 Histologic grading of femoral condyle
cartilage and synovium from stifles with osteoarthritis in a
rabbit model of bilateral medial meniscectomy with
medial collateral transection (n=10 animals per time
period). Bilateral joint lavage with saline was performed
in 5 rabbits, with the remaining animals acting as
controls. Joint lavage was performed at 1, 2, and 3 weeks
after meniscectomy and euthanasia performed 1 week
after lavage. (A) Histologic grading of cartilage. (B)
Histologic grading of synovium.∗P<0.05 versus control
group, which received no lavage treatment. Source: Fu
et al. 2009. Reproduced with permission from John Wiley
& Sons, Inc.

better than those after sham surgery (Sihvo-

nenet al. 2013), suggesting that joint lavage

may have a role in the relief of pain in selected

patients.

Mechanism for relief of joint pain

Few experimental data are available to pro-

vide insight into the mechanism by which joint

lavage might induce relief from joint pain.

However, in an experimental study using a

rabbit meniscectomy model, joint lavage was

found to significantly reduce joint degenera-

tion at 1 to 3 weeks after induction of joint

instability (Fuet al. 2009). Synovial inflam-

mation and degradation of articular cartilage

were both significantly reduced (Figure 24.1

and Table 24.1) (Fuet al. 2009). Joint lavage treat-

ment also led to reduced expression of the pro-

inflammatory cytokines interleukin-1β(IL-1β)

and tumor necrosis factor-alpha (TNF-α)insyn-

ovial fluid (Fuet al. 2009).

Conclusions

Collectively, these clinical trial and experimen-

tal findings suggest that joint lavage may have

efficacy in the treatment of arthritis, particularly

through reduction of joint inflammation. Meta-

analysis of data from randomized, controlled

Table 24.1 Influence of joint lavage on inflammatory markers in synovial fluid in a rabbit meniscectomy and medial
collateral transection model.

Period after meniscectomy before joint lavage

Marker 1 week (n=10) 2 weeks (n=10) 3 weeks (n=10)

IL-1β(pg ml–1)

Control (n=5/time point) 81.35±2.41 67.39±2.95 53.86±3.79

Saline lavage (n=5/time point) 35.79±3.50∗ 39.85±4.78∗ 29.94±3.99∗

TNF-α(pg ml–1)

Control (n=5/time point) 599.36±25.40 761.97±17.28 446.32±26.83

Saline lavage (n=5/time point) 313.02±24.61∗ 459.15±18.15∗ 309.88±27.69∗

Note: Euthanasia was performed at 1 week after lavage. IL-1βand TNF-αconcentrations were determined using ELISA.
∗P<0.05 versus control group.

Reproduced from Fuet al. (2009), with permission from Wiley Blackwell.
IL-1β, interleukin-1β; TNF-α, tumor necrosis factor-alpha.