Is Arthroscopy an Appropriate ...
Is Arthroscopy an Appropriate Surgical Procedure for Knee Osteoarthritis?
A DIFFERENT CLINICAL RATING SYSTEM AND RESULTS
Articol din publicatia Timisoara Medical Journal nr. 2/2005
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Cosmin Corneliu Pop, Jenel Marian Patrascu, Dan V. Poenaru
2nd Orthopaedics and Traumatology Clinic, Victor Babes University of Medicine and Pharmacy, Timisoara
Cosmin Corneliu Pop, 50 Al. Odobescu Str., Timisoara
The modern surgical treatment of primary or secondary knee osteoarthritis (OA) includes a variety of methods. Arthroscopy is the less invasive procedure of all but this technique needs an expensive equipment and a skilled orthopaedic surgeon. Favourable postoperative results are conditioned by a correct indication. The aim of the study was to evaluate using an own-devised clinical rating system the effects of arthroscopic debridement in selected patients diagnosed with knee OA. Material and method:
103 patients (74 females), aged between 45 and 75 years, with symptomatic osteoarthritis of the knee, underwent arthroscopic debridement after failure of medical and physical management. The clinical diagnostic was sustained by plain radiographs. The radiographic findings were described using the Kellgren-Lawrence grading scheme while the degenerative cartilage lesions were described using the Outerbridge principles. The pre and postoperative outcome was measured at 6 months and one year (84 patients at the last evaluation, follow-up period: 19 months) using an own clinical rating system. The arthroscopic procedures included segmentary synovectomy, excision of hypertrophic plicae, abrasion of marginal clinically relevant osteophytes, resection of loose chondral flaps and unstable meniscal tears, loose bodies ("articular mice") removal, abrasion chondroplasty and articular lavage. Drilling of the subchondral bone was not performed.
The medial compartment was more frequently and severely involved, with 62% of the knees showing grade 3 or 4 involvement, according to the system described by Outerbridge. In contrast, both the lateral and the patello-femoral compartment had grade 3 or 4 changes in only 26% and 21% of the knees, respectively. Hypertrophied synovitis was detect in all knees, loose bodies in 12 joints and incomplete lesions of the anterior cruciate ligament (ACL) in 13 knees. 61 patients had an unstable uniformly degenerative meniscal tear; 39 tears were in the medial meniscus, 13 were in the lateral meniscus, and 9 were combined. The complications following arthroscopic debridement in these patients were represented by moderate diffuse knee pain, pain localized on both sides of the joint, and swelling. No septic arthritis or symptomatic deep venous thrombosis secondary to knee arthroscopy was recorded. At the final evaluation the results were excellent and good in 46 (54.75%) patients according to the described clinical rating system.
Of great importance in achieving best results by performing arthroscopy in knees with degenerative cartilage lesions is to establish the correct indication (mild and moderate OA); thus it is important to counsel patients about the limited indications and palliative results. Decrease of the knee pain level is the most common short- and medium term result obtained after debridement arthroscopy. Our evaluation method may serve as an alternative to the existing and well-known clinical rating systems and there is the possibility to add new variables in purpose to improve the results specificity.