ARTHROSCOPY IN KNEE OSTEOARTHRITIS

Abstract

Introduction

There are numerous arthroscopic techniques available for the treatment of femorotibial osteoarthritis. Advances in arthroscopic technology have made arthroscopic treatment a widespread accepted treatment. Short-term pain relief after arthroscopic treatment in degenerative conditions of the knee has been well established, however this this not the case for the long-term results.

One of the reasons why arthroscopic procedures are well accepted is the favorable risk–benefit ratio, when compared to more invasive procedures like realignment osteotomies, unicompartmental or even total knee arthroplasty (15,16,17,18,19,21,26) Very often the arthroscopic procedure is offered to the patient as a temporizing or “time gaining” measures (11,23,24). However their efficacy is often unequal. Almost no prospective controlled studies are yet available. Arthroscopic mosaicplasty techniques as well as arthroscopically assisted autologous chondrocyte transplantations are – in this context – not regarded upon as treatment options for the osteoarthritic knee and are therefore described elsewhere.

Arthroscopic techniques in knee osteoarthritis

• - (Partial) Meniscectomy

• - Chondral Shaving

• - Removal of osteophytes

• - Removal of loose bodies

• - Synovectomy

• - Subchondral drilling techniques (Pridie)

• - Abrasive chondroplasty

• - Microfracturing techniques

Results published in peer-reviewed journals

• - (Partial) Meniscectomy: Results more dependent on the status of the knee joint, than on the age of the patient (15,17). For the treatment of chondrocalcinosis there are controversing results: Many authors found actually chondrocalcinosis to be an adverse prognostic factor (6,8,19). Meniscectomy is not always a benign procedure (5)

• - Chondral Shaving: This technique of chondral debridement, removal of cartilaginous flaps etc. has become very accepted with the advent of motorized instruments. Positive short-term results have been published, on the long-term this treatment however still fails to have proven efficacy (1,2,3,9,10,11). In some studies simple needle lavage, as performed by many rheumatologists, proved as effective as the arthroscopic method (4,8,17).

• - Removal of osteophytes: Several studies show a benefit, when mechanically disturbing osteophytes are removed (3,16)

• - Removal of loose bodies: One of the most rewarding arthroscopic techniques. Only free bodies in the anterior compartment of the knee are responsible for blocking, catching and/or pain (6,9)

• - Synovectomy: At the first moment making sense – removing inflamed synovia may be of benefit to the patient, we caution. Even when utilizing some of the newer radio-frequency ablation devices (Arthro-care® etc), important postoperative hemarthrosis may occur and may cause longstanding postoperative problems after knee arthroscopy (18,19)

• - Subchondral drilling: Originally described by Pridie in 1959, this technique of “subchondral stimulation” creating and stimulating re-growth of type I collagen layers has been adapted to arthroscopic techniques (22)

• - Abrasive chondroplasty: This rather aggressive technique, introduced by Lanny Johnson in 1986, has a decreased popularity, since almost nobody but the creator reported good mid- to long-.term results (7,12,13,25)

• - Microfracturing: A similar technique to the Pridie drilling technique, however avoiding any heat damage due to the fact that the perforations of the subchondral plate are performed by “ice-picks”. Its advocates report good to excellent results on the short-term (20,27,28)