- See:
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Knee Joint Menu:
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Arthroscopic Repair of the Meniscus
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Arthroscopy of the Arthritic Knee:
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Chondral and Osteochondral Injuries of the Knee
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Meniscal Tears:
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Osteoarthritis of Knee:
- Discussion:
- arthroscopic lavage alone may be of some benefit;
- debridement has little value for long-standing or severely OA;
- Indications:
- indicated in pts for whom other procedures are contraindicated.
- to postpone
total knee arthroplasty;
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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;
- Arthroscopy of the Knee:
- 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. LL Johnson MD Arthroscopy: Vol 2(1): 54-69. 1986.
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Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses.
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microfracture for DJD:
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Treatment of osteoarthritis of the knee with microfracture and rehabilitation.
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Cartilage healing after microfracture in osteoarthritic knees.
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Patient satisfaction and outcome after microfracture of the degenerative knee.
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Histologic and immunohistochemical characteristics of failed articular cartilage resurfacing procedures for osteochondritis of the knee: a case series.
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Histologic analysis of tissue after failed cartilage repair procedures
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Articular cartilage regeneration with microfracture and hyaluronic acid.
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Current treatment options for the restoration of articular cartilage.
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Soft tissue allografts for knee reconstruction in sports medicine.
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Articular Cartilage Repair Using a Resorbable Matrix Scaffold.
Arthroscopic debridement of the arthritic knee.
Arthroscopic lavage and debridement for osteoarthritis of the knee.
Selection criteria for knee arthroscopy in the osteoarthritic patient. PJ Novak and BR Bach. Orthop. Rev. 1993. p 798-804.
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. RT Burks. Arthroscopy Vol 6. 1990. p 43-47.
Arthroscopic Débridement for Osteoarthritis of the Knee.
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