Roy K. Aaron, MD, Adam H. Skolnick, MD, Steven E. Reinert, MS and Deborah McK. Ciombor, PhD
The Journal of Bone and Joint Surgery (American). 2006; 88:936-943
The role of arthroscopy in the treatment of osteoarthritis of the knee is controversial and there is no consensus reached on clinical, radiographic and intraoperative characteristics and quantification of its benefit. The authors have devised a cross sectional study of a consecutive cohort of 122 patients who underwent arthroscopic debridement for the treatment of osteoarthritis of the knee to see if there is any benefit. 110 patients completed the study with a mean follow up of 34 months.
The pain was assessed using knee society scoring system. The radiological severity of the arthritis was also assessed. All the arthroscopies were performed by one surgeon and lesion severity was scored with the modified Noyes and Stabler grading system.
The mean pain score of all patients improved from 11.9 to 30.8 points postoperatively. The severity of pre-operative pain and the type of symptoms did not have any influence on the postoperative pain scores. 52 (90%) of 58 knees with mild arthritis, normal alignment and a joint space of >/= 3mm were improved substantially after arthroscopic debridement. 5 (25%) of 20 knees with severe arthritis, malalignment and joint space width of <2mm had substantial relief of symptoms. Knees with valgus alignment did worse. Severe cartilage lesions in all the three compartments were associated with poorer outcome.
The severity of lesion as assessed by clinical, radiographic and intraoperative findings was highly predictive of clinical outcomes of arthroscopic debridement of osteoarthritic knee. Knees with mild arthritis fare well and procedure should be strongly considered as appropriate. Knees with severe arthritis fared poorly. The outcomes of moderate arthritis of knee are still elusive. This study will probably a way forward to establish indications for arthroscopy of knee in osteoarthritis but needs further level I evidence studies.