Arthroscopic debridement of the knee

When you have knee osteoarthritis, the accepted practice is to try non-surgical, conservative treatment first when trying treatment. When nonsurgical treatments fail, it may be time to look into joint surgery. Arthroscopic debridement is a surgical option, but experts recommend it only for some patients, and for the right reasons.

Understanding Arthroscopic Debridement

You may have heard of more general arthroscopic debridements, such as arthroscopy, arthroscopic surgery, or knee arthroscopy. Specifically, arthroscopic debridement involves the use of surgical instruments to remove damaged cartilage or bone. Surgeons usually do a flush, called a joint lavage, to remove any debris around the affected joint. If loose bodies or debris remain after lavage, remove them.

Not long ago, arthroscopic debridement was very common in patients with osteoarthritis who were found to be unresponsive with conservative treatment. Almost as expected, a doctor will recommend examining the knee to see what is causing persistent osteoarthritis symptoms.But in 2002, an article was published in New England Journal of Medicine Changed perspective on arthroscopic debridement.

Researchers question effectiveness of arthroscopic debridement

Arthroscopic debridement is believed by some to remove debris and possibly inflammatory enzymes from the knee by flushing fluid through the joint during surgery. Others believe the improvement is due to the removal of cartilage flaps, torn meniscus fragments, synovial tissue, and loose fragments. But it’s really not clear what’s going on.

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The results of the study published in 2002 surprised many, many of whom swear by arthroscopic debridement to help their patients. Researchers began to suspect that arthroscopic debridement was no more effective than a placebo because they lacked any plausible explanation for how or why it worked.

In this study, 180 patients with knee osteoarthritis were randomly assigned to undergo arthroscopic debridement, arthroscopic lavage, or placebo surgery. During the study period, patients in the group receiving arthroscopic debridement or lavage reported no reduction in pain or improvement in joint function compared with the placebo group.

The study’s findings have had a huge impact, and there is confusion about who should undergo surgery.Have patients and insurers been paying big bucks for a procedure that’s less effective than a placebo?

Cochrane Review of Arthroscopic Debridement

A Cochrane review of arthroscopic debridement research was published in 2008, providing additional insights. The review included three randomized controlled trials involving a total of 271 patients. In one study, there was no significant difference in arthroscopic debridement compared with lavage. Compared with placebo (sham), arthroscopic surgery had worse outcomes in terms of pain and function at 2 weeks, with no significant difference after two years.

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The second study compared arthroscopic debridement with irrigation and concluded that arthroscopic debridement significantly reduced knee pain over five years. A third study compared arthroscopic debridement with closed needle lavage and concluded that there was no significant difference.

Other studies since then have come to the same conclusion: there is insufficient clinical evidence that arthroscopic debridement is effective in knee osteoarthritis and treatment is not recommended.

bottom line

The American Academy of Orthopaedic Surgeons (AAOS) incorporated these findings into their treatment recommendations for knee osteoarthritis. The AAOS states that it cannot recommend arthroscopic debridement and/or lavage for the treatment of osteoarthritis. This recommendation is largely based on the 2002 study mentioned above, as well as two other similar studies conducted later. However, this recommendation does not apply to people initially diagnosed with a torn meniscus, laxity or other knee disorders, and osteoarthritis.

Frequently Asked Questions

  • What is arthroscopic debridement?

    Arthroscopic debridement is a minimally invasive orthopaedic procedure that removes damaged cartilage or bone. Also known as scope or arthroscopic surgery, it involves lavage or irrigation of the joint to remove debris from around the joint. Any remaining loose fragments will be surgically removed.

  • Can arthroscopic debridement of the knee treat osteoarthritis?

    There is no evidence that arthroscopic debridement is effective in treating osteoarthritis. Several studies have found that scoping is not a more effective placebo treatment. In fact, the American College of Orthopaedic Surgeons no longer recommends arthroscopic debridement or lavage for osteoarthritis.

  • Does arthroscopic debridement worsen osteoarthritis?

    possible. A 2020 study found that people who underwent arthroscopic debridement for knee osteoarthritis were twice as likely to need a total knee replacement within five years as a control group.