The Hip: Preservation, Replacement and Revision

Arthroscopy of the Osteoarthritic Knee


- See:
      - Knee Joint Menu: 
              - Chondral and Osteochondral Injuries of the Knee and Meniscal Tears 

- Discussion:
    - arthroscopic lavage alone may be of some benefit;
    - debridement has little value for long-standing or severe osteoarthritis of knee 
            - where as, in the recent past it was standard of care to offer osteoarthritic patients an arthroscopic debridement as an alternative to replacement, the arthroscopic debridement option has been discredited after two landmark articles (Moseley) and (Kirkley) and a recent AAOS position statement;
        - indications: 
               - indicated in pts for whom other procedures are contraindicated.
               - to postpone total knee arthroplasty;
               - predictors of good outcome:
                       - preop pain present for short time;
                       - mechanical symptoms are present;
                       - radiographic changes are minimal 
                       - crystal deposits are present (see CPPD);
                       - normal mechanical axis alignment; 
                       - varus alignment w/ loss of medial joint space tends to have a poor outcome w/ arthroscopic washout and debridement; 
        - A controlled trial of arthroscopic surgery for osteoarthritis of the knee.
        - A randomized trial of arthroscopic surgery for osteoarthritis of the knee.
- Arthroscopy of the Knee: 
     - microfracture for DJD
     - autologous hamstring resurfacing arthroplasty
     - abrasion arthroplasty:
             - the motivation for this form of treatment is based on the observation that their is profuse vascularity of sclerotic lesions;
             - contra-indications: high activity level, wt more than 200 lbs, or significant angulatory deformity;
             - gentle arthroscopic intracortical debridement is carried out over the surfaced of the cortical lesion;
             - only the superfical 1-2 mm of the sclerotic bone is necrotic, and therefore additional debridement is not required;
             - this intra-cortical debridment is all that is required to allow biologic adherence of a blood clot to the surface;
             - if red bone is exposed, then the debridment is too deep;
             - after the intra-cortical debridement, the vascularity can be demonstrated by releasing the tourniquet and applying suction;
             - avoid debridement of the adjacent joint surface, so as to avoid possible ankylosis;
             - it is essential that patients remain non wt bearing on the operative side for one month;
             - references:
                     - Arthroscopic Abrasion Arthroplasty Historical and Pathological Perspective: Present Status.   
                     - Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses.

- medial release:
         - Arthroscopic medial release for medial compartment osteoarthritis of the knee: the result of a single surgeon series with a minimum follow-up of four years.



Arthroscopic debridement of the arthritic knee.

Arthroscopic lavage and debridement for osteoarthritis of the knee.

Selection criteria for knee arthroscopy in the osteoarthritic patient.      

High tibial osteotomy in the treatment of osteoarthritis of the knee. The role of preoperative arthroscopy.

Arthroscopic lavage of osteoarthritic knees.

Arthroscopy and degenerative arthritis of the knee: a review of the literature.    

Arthroscopic debridement for osteoarthritis of the knee: predictors of patient satisfaction.

CMS Manual System - (summary of changes for Arthroscopic lavage arthroscopic debridement for severe osteoarthritis of the knee)

ARTHROSCOPY FOR OSTEOARTHRITIS OF THE KNEE (medicare and medicaid policy) CIGNA MEDICAL COVERAGE POLICY

AETNA: Clinical Policy Bulletin: Arthroscopic Lavage and Debridement for Osteoarthritis of the Knee

A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee 

A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee

Research disputes effectiveness of arthroscopic surgery for knee OA

Can an anterior quadriceps release improve range of motion in the stiff arthritic knee?



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, September 7, 2012 11:37 am