{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T22:14:02Z","timestamp":1758924842867,"version":"3.40.5"},"reference-count":14,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T00:00:00Z","timestamp":1554768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Knee arthroscopy is a common orthopaedic procedure and often involves insertion of a needle through skin into a joint. This needle insertion can create epithelial tissue cut\u2010outs possibly containing commensal bacteria that can be flushed into the joint, and potentially lead to post\u2010arthroscopy septic arthritis. This study aims to assess the frequency of epithelial tissue cut\u2010out creation on insertion of different needle sizes at different angles to the skin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using an <jats:italic>ex\u2010vivo<\/jats:italic> porcine limb tissue model, needles of various gauge (14\u201323G) were inserted at angles of 90, 60, 45 and 30\u00b0 to the skin surface. Ten passes were undertaken at each angle. Needle lumen contents were then examined for solid tissue cut\u2010out.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred and eighty needle passes were performed resulting in 70 tissue cut\u2010outs (25%) containing solid material. This was more common amongst lower gauge needles. 8 of the 70 (11.4%) tissue cut\u2010outs contained macroscopic evidence of epithelium. The overall rate of epithelial tissue cut\u2010out was 2.9%. The 23G needle had the lowest rate of tissue cut\u2010out creation, occurring twice out of 40 passes (<jats:italic>P<\/jats:italic>\u2009=\u20090.002). Neither of these contained macroscopic epithelial tissue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hypodermic needle insertion through skin into a joint can create epithelial tissue cut\u2010out. Epithelial tissue cut\u2010out occurs more frequently with use of lower gauge needles. This study suggests use of a 23G needle during arthroscopy, inserted either at 60 or 90\u00b0 to the skin, to reduce epithelial tissue cut\u2010out and any potential contribution to post\u2010arthroscopy septic arthritis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.15131","type":"journal-article","created":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T06:41:14Z","timestamp":1554878474000},"page":"557-561","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Epithelial tissue cut\u2010out following needle insertion into a joint: a potential complication during arthroscopy"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2655-2570","authenticated-orcid":false,"given":"Daniel J.","family":"Epstein","sequence":"first","affiliation":[{"name":"Bendigo Health  Bendigo Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"McCullough","sequence":"additional","affiliation":[{"name":"Bendigo Health  Bendigo Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,4,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1603901"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2015.09.004"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513510677"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2015.107"},{"volume-title":"The Effect of Preoperative Skin Preparation on Bacterial Growth During Cardiac Surgery","year":"2013","author":"Falk\u2010Brynhildsen K","key":"e_1_2_6_6_1"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200505000-00007"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.5793.136"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.molimm.2014.10.023"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep45070"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-15830-7"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.905590"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-950X.2011.00969.x"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0265021508003906"},{"key":"e_1_2_6_15_1","first-page":"1151","article-title":"Propionibacterium acnes suture contamination in arthroscopic rotator cuff repair: a prospective randomized study","volume":"34","author":"Yamakado K","year":"2018","journal-title":"Art Ther."}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.15131","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.15131","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.15131","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T08:20:17Z","timestamp":1694334017000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.15131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,9]]},"references-count":14,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1111\/ans.15131"],"URL":"https:\/\/doi.org\/10.1111\/ans.15131","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"type":"print","value":"1445-1433"},{"type":"electronic","value":"1445-2197"}],"subject":[],"published":{"date-parts":[[2019,4,9]]},"assertion":[{"value":"2018-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}