SHORT-TERM CLINICAL AND FUNCTIONAL OUTCOMES FOLLOWING ARTHROSCOPIC DEBRIDEMENT AND LAVAGE IN EARLY TO MODERATE KNEE OSTEOARTHRITIS: A PROSPECTIVE LONGITUDINAL STUDY
Main Article Content
Keywords
Knee osteoarthritis, Arthroscopy, Debridement, Lavage, Kellgren-Lawrence, WOMAC, KSS, Visual Analog Scale
Abstract
A common disease affecting degenerative joints that reduces mobility and quality of life is knee osteoarthritis (OA). Although its effectiveness is still up for discussion, arthroscopic debridement and lavage have been suggested as an intermediate surgical option for patients with early to moderate OA who are suffering persistent mechanical symptoms that are not improving with conservative treatment. To assess the immediate clinical, functional, and radiological outcomes of arthroscopic debridement and lavage in patients with Kellgren-Lawrence Grade I–III knee OA who are not responding to non-operative therapy. Over 18 months, prospective longitudinal research was carried out at a tertiary care facility. Lavage and arthroscopic debridement were performed on 35 individuals. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Visual Analog Scale (VAS), and the Knee Society Score (KSS) were used to evaluate clinical results. Radiological alterations in osteophytes and joint space were assessed. Wilcoxon signed-rank tests and paired t-tests were used in the statistical analysis; p < 0.05 was deemed significant. Postoperative improvements in VAS (6.4 to 2.8), KSS (58 to 82), and WOMAC (74 to 48) ratings were substantial (p < 0.001). Radiographs showed reduced osteophyte and increased joint space, especially in KL Grade I–II patients. Only modest, self-limiting occurrences were observed, and the risk of complications was minimal, for certain individuals with early to moderate knee OA and mechanical symptoms, arthroscopic debridement and lavage provide safe, efficient temporary pain alleviation and enhanced functionality. In KL Grades I–II, the operation is most helpful, and in properly selected patients, it should be viewed as a bridge measure before arthroplasty.
References
2. Amin, N. H., Hussain, W., Ryan, J., Morrison, S., Miniaci, A., & Jones, M. H. (2017). Changes within clinical practice after a randomized controlled trial of knee arthroscopy for osteoarthritis. Orthopaedic journal of sports medicine, 5(4), 2325967117698439.
3. Brignardello-Petersen, R., Guyatt, G. H., Buchbinder, R., Poolman, R. W., Schandelmaier, S., Chang, Y., ... & Vandvik, P. O. (2017). Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ open, 7(5), e016114.
4. Buchbinder, R., Richards, B., & Harris, I. (2014). Knee osteoarthritis and role for surgical intervention: lessons learned from randomized clinical trials and population-based cohorts. Current opinion in rheumatology, 26(2), 138-144.
5. Caforio, M., & Nobile, C. (2021). Intra-articular administration of autologous purified adipose tissue associated with arthroscopy ameliorates knee osteoarthritis symptoms. Journal of Clinical Medicine, 10(10), 2053.
6. Collins, J. E., Katz, J. N., Dervan, E. E., & Losina, E. (2014). Trajectories and risk profiles of pain in persons with radiographic, symptomatic knee osteoarthritis: data from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 22(5), 622-630.
7. den Hertog, A., Gliesche, K., Timm, J., Mühlbauer, B., & Zebrowski, S. (2012). Pathway-controlled fast-track rehabilitation after total knee arthroplasty: a randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay. Archives of orthopaedic and trauma surgery, 132, 1153-1163.
8. Kon, E., Di Matteo, B., Delgado, D., Cole, B. J., Dorotei, A., Dragoo, J. L., ... & Sánchez, M. (2020). Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system. Expert opinion on biological therapy, 20(12), 1447-1460.
9. Koster, A., Stevens, M., van Keeken, H., Westerveld, S., & Seeber, G. H. (2023). Effectiveness and therapeutic validity of physiotherapeutic exercise starting within one year following total and unicompartmental knee arthroplasty for osteoarthritis: a systematic review. European Review of Aging and Physical Activity, 20(1), 8.
10. Krych, A. J., Bert, J. M., & Levy, B. A. (2013). Treatment of OA of the knee in the middle-aged athlete: the role of arthroscopy. Sports medicine and arthroscopy review, 21(1), 23-30.
11. Langworthy, M., Dasa, V., & Spitzer, A. I. (2024). Knee osteoarthritis: disease burden, available treatments, and emerging options. Therapeutic Advances in Musculoskeletal Disease, 16, 1759720X241273009.
12. MacLean, S. B., Oni, T., Crawford, L. A., & Deshmukh, S. C. (2013). Medium-term results of arthroscopic debridement and capsulectomy for the treatment of elbow osteoarthritis. Journal of shoulder and elbow surgery, 22(5), 653-657.
13. Moseley, J. B., O'malley, K., Petersen, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H., ... & Wray, N. P. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, 347(2), 81-88.
14. Malempati, C., Jacobs, C. A., & Lattermann, C. (2017). The early osteoarthritic knee: implications for cartilage repair. Clinics in Sports Medicine, 36(3), 587-596.
15. Marsh, J. D., Birmingham, T. B., Giffin, J. R., Isaranuwatchai, W., Hoch, J. S., Feagan, B. G., ... & Fowler, P. (2016). Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee. BMJ open, 6(1), e009949.
16. Moreira, J., Miguel, S., Delgado, B., & Boto, P. (2024). Patient-reported outcome measures in rehabilitation after knee surgery: a rapid systematic review. Journal of Public Health, 1-15.
17. Palazzo, C., Nguyen, C., Lefevre-Colau, M. M., Rannou, F., & Poiraudeau, S. (2016). Risk factors and burden of osteoarthritis. Annals of physical and rehabilitation medicine, 59(3), 134-138.
18. Pavone, V., Vescio, A., Turchetta, M., Giardina, S. M. C., Culmone, A., & Testa, G. (2021). Injection-based management of osteoarthritis of the knee: a systematic review of guidelines. Frontiers in Pharmacology, 12, 661805.
19. Piuzzi, N. S., Slullitel, P. A., Bertona, A., Oñativia, I. J., Albergo, I., Zanotti, G., ... & Comba, F. M. (2016). Hip arthroscopy in osteoarthritis: a systematic review of the literature. Hip International, 26(1), 8-14.
20. Rai, D., Singh, J., Somashekharappa, T., & Singh, A. (2021). Platelet-rich plasma as an effective biological therapy in early-stage knee osteoarthritis: One-year follow-up. SICOT-J, 7, 6.
21. Rodríguez-Merchán, E. C. (2022). Intra-articular platelet-rich plasma injections in knee osteoarthritis: a review of their current molecular mechanisms of action and their degree of efficacy. International journal of molecular sciences, 23(3), 1301.
22. Rucinski, K., Cook, J. L., Crecelius, C. R., Stucky, R., & Stannard, J. P. (2019). Effects of compliance with procedure-specific postoperative rehabilitation protocols on initial outcomes after osteochondral and meniscal allograft transplantation in the knee. Orthopaedic journal of sports medicine, 7(11), 2325967119884291.
23. Sancheti, P., Shetty, V. D., Dhillon, M. S., Sprague, S. A., & Bhandari, M. (2017). India-based knee osteoarthritis evaluation (iKare): A multi-centre cross-sectional study on the management of knee pain and early osteoarthritis in India. Clinics in orthopedic surgery, 9(3), 286.
24. Singh, A., Das, S., Chopra, A., Danda, D., Paul, B. J., March, L., ... & Antony, B. (2022). Burden of osteoarthritis in India and its states, 1990–2019: findings from the Global Burden of Disease Study 2019. Osteoarthritis and Cartilage, 30(8), 1070-1078.
25. van den Bekerom, M. P., Patt, T. W., Rutten, S., Raven, E. E., van de Vis, H. M., & Albers, G. R. (2007). Arthroscopic debridement for grade III and IV chondromalacia of the knee in patients older than 60 years. The journal of knee surgery, 20(04), 271-276.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Aniket Koley
MBBS, PGT (MS Orthopaedics), Dept of Orthopaedics,Nrs Medical College And Hospital
Dr Gopinath Maiti
MS Orthopaedics, Professor & HOD, Dept of Orthopaedics, Nrs Medical College And Hospital
Dr Arumoy Bhuimali
MBBS, MS Orthopaedics, Assistant Professor, Dept of Orthopaedics, Nrs Medical College and Hospital
Dr Aniruddha Mondal
DMRT, DNB ORTHOPAEDICS, Assistant Professor,Dept of Orthopaedics (Nrs Medical College & Hospital)
Dr Satyaki Dandi
MBBS, MS (Orthopaedics), DNB Orthopaedics, SR (NRS Medical College and Hospital)
Dr Subhamoy Majee
MBBS, PGT (MS ORTHOPAEDICS), Nrs Medical College AandHospital
Dr. Shreyans Agrawal
PGT MS ORTHOPAEDICS, MBBS (hons) MRCS (Edinb.). Dept Of Orthopaedics, Nrs Medical College and Hospital