Influence of intra-articular injectate volume on joint surface coverage and leakage following canine elbow arthroscopy: A cadaveric study.

Reduced intra-articular volumes achieve complete joint coverage post-arthroscopy, but leakage should always be anticipated.

This randomized cadaveric study investigated whether reduced intra-articular (IA) injection volumes following canine elbow arthroscopy could maintain complete synovial surface coverage while minimizing post-procedural leakage. Using 40 elbow joints from 20 cadavers (mean weight 29.9 kg), researchers performed standardized medial elbow arthroscopy with three portals and injected India ink volume-matched to whole, half, or quarter doses of 0.75% ropivacaine (0.5 mg/kg base dose) via the egress portal. After 10 passive flexion-extension cycles, a masked investigator assessed synovial coverage and leakage severity. Complete (100%) synovial surface coverage was achieved across all 40 joints regardless of injection volume, including the quarter-dose group. However, leakage occurred in every dose group with comparable distributions of mild, moderate, and severe grades, indicating that volume reduction did not mitigate extravasation. Portal placement succeeded on the first attempt in 80% of elbows and second attempt in the remaining 20%. These findings suggest clinicians may have flexibility to reduce IA injection volumes without compromising joint surface drug coverage, which has implications for local anesthetic dosing strategies—particularly relevant when managing total dose toxicity concerns. However, practitioners should anticipate some degree of leakage regardless of volume administered, as post-arthroscopic portal patency appears to be the primary driver of extravasation rather than injectate volume. The cadaveric model limits direct clinical translation, and in vivo studies are warranted to confirm pharmacokinetic and analgesic efficacy of reduced volumes.

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