Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage-Based Procedures

When compared with fluid arthroscopy, carbon dioxide (CO₂) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon's view. Despite the advantages of CO₂ insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety.

To investigate the safety profile of CO₂ insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO₂ insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field.

Case series; level of evidence, 4.

A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO₂ insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO₂ insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients' electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes.

We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO₂ insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema.

The results of this case series suggest CO₂ insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.