- Discussion:
- arthroscopic lavage alone may be of some benefit;
- debridement has little value for long-standing or severe osteoarthritis of knee - where as, in the recent past it was standard of care to offer osteoarthritic patients an arthroscopic debridement as an alternative to
replacement, the arthroscopic debridement option has been discredited after two landmark New England Journal of Medicine
articles Moseley and Kirkley and a recent AAOS position statement;
- indications:
- indicated in pts for whom other procedures are contraindicated.
- to postpone total knee arthroplasty;
- predictors of good outcome:
- preop pain present for short time;
- mechanical symptoms are present;
- radiographic changes are minimal
- crystal deposits are present (see CPPD);
- normal mechanical axis alignment;
- varus alignment w/ loss of medial joint space tends to have a poor outcome w/ arthroscopic washout and debridement;
- Arthroscopy of the Knee:
- microfracture for DJD:
- autologous hamstring resurfacing arthroplasty - abrasion arthroplasty:
- the motivation for this form of treatment is based on the observation that their is profuse vascularity of sclerotic lesions;
- contra-indications: high activity level, wt more than 200 lbs, or significant angulatory deformity;
- gentle arthroscopic intracortical debridement is carried out over the surfaced of the cortical lesion;
- only the superfical 1-2 mm of the sclerotic bone is necrotic, and therefore additional debridement is not required;
- this intra-cortical debridment is all that is required to allow biologic adherence of a blood clot to the surface;
- if red bone is exposed, then the debridment is too deep;
- after the intra-cortical debridement, the vascularity can be demonstrated by releasing the tourniquet and applying suction;
- avoid debridement of the adjacent joint surface, so as to avoid possible ankylosis;
- it is essential that patients remain non wt bearing on the operative side for one month;
- references:
- Arthroscopic Abrasion Arthroplasty Historical and Pathological Perspective: Present Status. LL Johnson MD Arthroscopy: Vol 2(1): 54-69. 1986.
- Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses.
