We aimed to determine whether ox muzzle drainage in knee arthroscopy offers a significant benefit in surgical time, irrigation volume, and Postoperative anterior knee pain compared to the normal procedure. The results of this study indicate that ox muzzle drainage with double traction does reduce the operative time and increase the amount of irrigation possible, while not changing the rate of operative complications Reduces subpatellar fat pad injury and anterior knee pain.This may be due to enhanced visualization due to the better drainage provided by the bovine muzzle drainage tube to reduce fluid turbulence and to reduce the incidence of anterior knee pain caused by the removal of the Infrapatellar Fat Pad (IFP). IFP is a dynamic structure, which is easily disturbed by surgery because of its obvious displacement during knee movement.Surgical injury of IFP is believed to be the cause of postoperative anterior knee pain. Repeated surgical instrument stimulation will damage IFP, and fibrosis, lymphocyte infiltration and vascular proliferation will aggravate the pain [10–11]。
Yanmis L [12]andKuo CL[13]think thorough irrigation for joint capsule expansion and a guarantee of clear vision are necessary for the operation. Irrigation can remove the bleeding and debris, which is helpful for observing the interior joint cavity more clearly. At present, there are two methods for knee joint cavity irrigation: suspensory gravity irrigation and perfusion pressure pump irrigation. Suspensory gravity irrigation is a classic surgical method with advantages of lower equipment costs and simpler technology. However, the disadvantage is that the perfusion pressure is unstable. Low pressure can cause vision to be blurred by joint cavity hemorrhage, whereas high pressure can cause turbulence, which is bad for vision and increases the degree of edema after the operation. The perfusion pressure pump method offers the advantage of an adjustable pressure, which helps maintain clear vision and reduces the operative time.[14, 15] It can alleviate the degree of edema after operation by reducing the infiltration of liquid. Moreover, it can prevent the phenomenon of water interruption and air entering the joint cavity. However, the related equipment is associated with certain costs. On the other hand, the pressure difference of less than 50 mmHg compared with the systolic pressure can reduce bleeding and improve the clarity of vision[16, 17], although it also may increase the risk of perfusion fluid extravasation and lead to osteofascial compartment syndrome[18]. Seig thought that the perfusion pump could shorten the operation time compared with suspensory irrigation.[19] Contrarily, Tatari proposed that although use of drains can improve the vision, Suspensory irrigation cannot provide clear vision, because the drainage may be blocked by the subcutaneous tissue and joint capsule under the lateral edge of the incision.Thus, a drain tube is needed to discharge the irrigation fluid containing blood and debris, which further extends the operation time.[20,, 21]
Ox muzzle drainage permits sufficient drainage in multiple conditions such as osteomyelitis[22, 23].Temporary application Ox muzzle drainage was associated with three advantages. First, it holds the subcutaneous tissue under the edge and prevents aggregation of the knee joint capsule cannot, which benefits clear vision. Secondly, the ox muzzle drainage tube can effectively pull open the fat pad to improve the surgical view, instead of cleaning the fat pad, thus shortening the operation time. Thirdly, the surgical instruments can be placed within the joint cavity to place the tube easily, avoiding unnecessary side injury to structures such as the articular cartilage, meniscus, and cruciate ligament.[24, 25] Lastly, it may avoid osteofascial compartment syndrome caused by fluid infiltration to the crural fascia upon osmotic pressure.[26, 27] Therefore, ox muzzle drainage is theoretically an ideal choice for knee arthroscopy.
Every 5 to 10 minutes, we looked at the quality of visibility (NRS) by the overall rating of the physician, to see if it could provide a better visualization,According to the method used by Tuijthof [28] et al, visual clarity is measured and the ratio of "good visibility" is expressed (NRS & gt;7).We found that the bovine muzzle drainage tube improved visual clarity.Turbidity is the most common source of disturbance in knee arthroscopy and is present during a considerable percentage of the operation time. Our results show that for routinely performed arthroscopic knee operations, the ox muzzle drainage system resulted in a significantly reduced presence of turbidity. This finding can be explained by the continuous flow that spanned a wider area due to the traction of the drainage tube, as opposed to the flow caused by leakage along the portals. Meanwhile, the larger amount of irrigation used in ox muzzle drainage group further supports this conclusion. In addition, the shorter operation time in the ox muzzle drainage group also prompted faster and easier insertion and removal of the surgical instruments.
Our study had some limitations. Our series was not large, because this is a new attempt in knee arthroscopy. Moreover, our follow-up time was short. Thus, a study with a larger population and longer follow-up is needed to better evaluate the effectiveness and convenience of ox muzzle drainage in knee arthroscopy. Furthermore, many experienced surgeons can still create a clear surgical view and shorten the operation time effectively without ox muzzle drainage. Therefore, in our opinion, ox muzzle drainage is most helpful for beginner surgeons performing knee arthroscopy.