ARTHROSCOPIC DEBRIDEMENT & REPAIR

Abstract

The French word debridement means the removal of the foreign matter or devitalised tissue from a lesion until surrounding healthy tissue is exposed. Arthroscopic techniques facilitated the removal of the intra-articular torn menisci, loose bodies, degenerated articular cartilage, and osteophytes. However, debridement procedure itself cannot induce tissue regeneration thus, the basic goal of the procedure is relief of pain. If pain can be relieved by non-surgical means very few patients can be considered for arthroscopic management. Debridement of early osteoarthritic knees can be carried out with a minimally invasive procedure with extremely low risk of infection and morbidity. However, it should be understood that this procedure is basically indicated for early degenerative knee disease with mechanical problems such as torn menisci or flap lesion of the cartilage.

The general principle is to resect and remove less tissue and preserve the anatomical structure as much as possible. For example in the case of a degenerated horizontal tear of the medial meniscus, the torn fragment can be left alone as long as the remaining segment is not unstable. Arthroscopic removal and shaving of the fibrillated articular cartilage can minimise and reduce crepitation and abnormal sensation of the patello-femoral and tibio-femoral joint but the articular cartilage will not regenerate by this procedure. The longer-term knee function will be better if the anatomical structure is preserved as much as possible.

With increasing awareness of the important functions of the meniscus and the improved understanding of the operative procedure, arthroscopic meniscal repair has become a widely accepted method of treatment for the symptomatic peripheral meniscal tears in the younger athletic population. However, in the patients with degenerative arthritis this procedure is rarely recommended due to the degenerative nature of the repaired meniscus itself.

Recent studies and publications have shown that articular cartilage defects in the younger population can be managed by cartilage cell transplantation, periosteal or perichondral graft, osteochondral autograft, and osteochondral allograft. Good results can be expected by these procedures as long as the cartilage defect is contained and the rest of the cartilage is healthy. Unfortunately, this is not the story for most of the degenerative knee problems thus, excellent results are expected to be limited by arthroscopic treatment.

Relatively large chondral defects with associated degenerative change can be managed by arthroscopic drilling, abrasion arthroplasty, and microfracture. Although cartilage regeneration by these techniques is not predictable and consistent, reasonable results can be obtained in the selective cases with controlled postoperative management. The patients should not be too old and 4 to 8 weeks postoperative non-weight-bearing is needed. Cases treated with this type of approach will be presented and discussed in this presentation.