Mechanical Symptoms of Osteoarthritis in the Knee and Arthroscopy

Abstract

The potential benefit of arthroscopy as a treatment for knee osteoarthritis is contentious, with National Institute for Health and Care Excellence stating that, “There is uncertainty regarding the efficacy of the procedure.” This is a study of a consecutive series of patients with osteoarthritis of the knee, suffering from mechanical symptoms, such as giving way, catching, and locking, and undergoing arthroscopic debridement, including chondroplasty and meniscectomy where appropriate. A total of 33 patients were reviewed at a mean period of 24 months (standard deviation 3 months) and follow-up data were obtained for 28 of these patients. Primary outcomes measured were: number of mechanical symptom episodes per week and visual analog scores for pain. Secondary outcomes measured were: Oxford, Lysholm, and Tegner knee scores together with arc of motion of the joint. Seven patients went on to have a knee replacement within 2 years. In the patient subgroup who did not require further surgery, there was statistically significant improvement in giving way (p = 0.0184) and marginally significant improvement in catching and locking (p = 0.1105 and p = 0.087, respectively). There were statistically significant improvements found in the Oxford and Lysholm scores (p < 0.0001). An average decrease of 1.9 in the VAS pain score was observed that was also statistically significant (p < 0.0007) and an average improvement of 10 degrees in the arc of motion was noted, which was marginally significant (p = 0.0687). To our knowledge, this is the first study with a primary outcome measure of mechanical symptoms experienced by patients. The results overall suggest that patient symptoms improved following arthroscopic treatment. As a result, episodes of mechanical symptoms should be important criteria for clinicians in determining the patient suitability for arthroscopic debridement.

Keywords

mechanical - arthroscopy - knee - osteoarthritis

• References

• 1 Burman M, Finkelstein H, Mayer L. Arthroscopy of the knee joint. The J Bone Joint Surg Am 1934; 16 (2) 255-268
• 2 Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev 2008; (1) CD005118
• 3 NICE. Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis (IPG230). Available at: http://www.nice.org.uk/IPG230 . Issued August 2007 [Internet]. Accessed May 14, 2014
• 4 Jordan KM, Arden NK, Doherty M , et al; Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62 (12) 1145-1155
• 5 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (4) 494-502
• 6 Stuart MJ, Lubowitz JH. What, if any, are the indications for arthroscopic debridement of the osteoarthritic knee?. Arthroscopy 2006; 22 (3) 238-239
• 7 Bennell KL, Hunter DJ, Hinman RS. Management of osteoarthritis of the knee. BMJ 2012; 345: e4934
• 8 Bhattacharyya T, Gale D, Dewire P , et al. The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am 2003; 85-A (1) 4-9
• 9 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998; 80 (1) 63-69
• 10 Xie F, Ye H, Zhang Y, Liu X, Lei T, Li SC. Extension from inpatients to outpatients: validity and reliability of the Oxford Knee Score in measuring health outcomes in patients with knee osteoarthritis. Int J Rheum Dis 2011; 14 (2) 206-210
• 11 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10 (3) 150-154
• 12 Marx RG, Jones EC, Allen AA , et al. Reliability, validity, and responsiveness of four knee outcome scales for athletic patients. J Bone Joint Surg Am 2001; 83-A (10) 1459-1469
• 13 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
• 14 Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 2007; 15 (4) 393-401
• 15 Steadman JR, Ramappa AJ, Maxwell RB, Briggs KK. An arthroscopic treatment regimen for osteoarthritis of the knee. Arthroscopy 2007; 23 (9) 948-955
• 16 Krych AJ, Bert JM, Levy BA. Treatment of OA of the knee in the middle-aged athlete: the role of arthroscopy. Sports Med Arthrosc Rev 2013; 21 (1) 23-30
• 17 Aichroth PM, Patel DV, Moyes ST. A prospective review of arthroscopic debridement for degenerative joint disease of the knee. Int Orthop 1991; 15 (4) 351-355
• 18 Merchan EC, Galindo E. Arthroscope-guided surgery versus nonoperative treatment for limited degenerative osteoarthritis of the femorotibial joint in patients over 50 years of age: a prospective comparative study. Arthroscopy 1993; 9 (6) 663-667
• 19 Kuraishi J, Akizuki S, Takizawa T, Yamazaki I, Matsunaga D. Arthroscopic lateral meniscectomy in knees with lateral compartment osteoarthritis: a case series study. Arthroscopy 2006; 22 (8) 878-883
• 20 Dervin GF, Stiell IG, Rody K, Grabowski J. Effect of arthroscopic débridement for osteoarthritis of the knee on health-related quality of life. J Bone Joint Surg Am 2003; 85-A (1) 10-19
• 21 Shannon FJ, Devitt AT, Poynton AR, Fitzpatrick P, Walsh MG. Short-term benefit of arthroscopic washout in degenerative arthritis of the knee. Int Orthop 2001; 25 (4) 242-245
• 22 Moseley JB, O'Malley K, Petersen NJ , et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347 (2) 81-88
• 23 Siparsky P, Ryzewicz M, Peterson B, Bartz R. Arthroscopic treatment of osteoarthritis of the knee: are there any evidence-based indications?. Clin Orthop Relat Res 2007; 455 (455) 107-112
• 24 Kirkley A, Birmingham TB, Litchfield RB , et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008; 359 (11) 1097-1107
• 25 Reichenbach S, Rutjes AW, Nüesch E, Trelle S, Jüni P. Joint lavage for osteoarthritis of the knee. Cochrane Database Syst Rev 2010; (5) CD007320
• 26 Sihvonen R, Paavola M, Malmivaara A , et al; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369 (26) 2515-2524
• 27 Elattrache N, Lattermann C, Hannon M, Cole B. New England journal of medicine article evaluating the usefulness of meniscectomy is flawed. Arthroscopy 2014; 30 (5) 542-543
• 28 Rossi MJ, D'Agostino Jr RB, Provencher MT, Lubowitz JH. Could the new England journal of medicine be biased against arthroscopic knee surgery?. Arthroscopy 2014; 30 (5) 536-537
• 29 Krych AJ, Carey JL, Marx RG , et al. Does arthroscopic knee surgery work?. Arthroscopy 2014; 30 (5) 544-545
• 30 Gibson JN, White MD, Chapman VM, Strachan RK. Arthroscopic lavage and debridement for osteoarthritis of the knee. J Bone Joint Surg Br 1992; 74 (4) 534-537