Alternative irrigation fluids in orthopedics during critical times: lactated Ringer's and multielectrolytes solution maintain cartilage integrity similarly to normal saline—an in vitro osteochondral explant model

<h2>Abstract</h2><h3>Introduction</h3> Hurricane Helene in September 2024 disrupted saline distribution, causing a months-long shortage in U.S. hospitals. Saline is essential for irrigation in orthopedic procedures, including arthroscopy. While alternatives such as lactated Ringer's and multi-electrolyte solutions have gained attention, evidence comparing their safety and efficacy to saline remains limited. <h3>Objectives</h3> To evaluate the effect of saline, Lactated Ringer's, and multi-electrolytes solution on chondrocyte viability and extracellular matrix release in an in vitro osteochondral (OC) explant model. <h3>Methods</h3> OC explants (6x10mm) were harvested from OC allograft remnants and tested with saline, Lactated Ringer's, and a multi-electrolytes solution. Explants were incubated in each solution (1 hour, 37°C), then analyzed for chondrocyte viability and gene expression, while the conditioned supernatant was assessed for glycosaminoglycan (GAG) release. Additional explants were flushed with one of the solutions using a syringe and 18-gauge needle to simulate pulse lavage, followed by chondrocyte viability analysis. <h3>Results</h3> No significant differences in chondrocyte viability were observed across the three solutions (p>0.90). Compared to saline, gene expression analysis showed Lactated Ringer's reduced MMP13, COL2A1, and IL6, though not significantly, while the multi-electrolytes significantly reduced all three (p<0.001). No significant differences were found between Lactated Ringer's and multi-electrolytes. GAG release was similar across the three solutions. <h3>Conclusions</h3> Neither Lactated Ringer's nor multi-electrolytes solution caused increased chondrocyte death or cartilage damage compared to saline in this in vitro model, both for incubation and bone marrow flushing. These solutions may be viable alternatives for preserving cartilage integrity in orthopedic procedures.