Arthroscopic Debridement Ineffective in Patients with Knee Osteoarthritis

Arthroscopic debridement (AD) is not effective for reducing pain and improving function in patients with osteoarthritis (OA) of the knee, according to the results of a new study.

Researchers from Khon Kaen University (Khon Kaen, Thailand) searched the Cochrane Central Register of Controlled Trials (CENTRAL), Medline (1966 - 2006), Cinhal (1982 - 2006), Embase (1988 - 2006), and Web of Science (1900 - 2006), as well as the bibliographies, reference lists, and cited web sites of identified papers. Selection criteria were randomized controlled trial or controlled clinical trial design; comparison of efficacy of AD versus another surgical procedure, including sham or placebo surgery and other nonsurgical interventions; and participants diagnosed with primary or secondary knee OA without other joint involvement or conditions requiring long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Pain relief and improved function of the knee were the primary endpoints.

The three randomized controlled trials included in the review enrolled 271 patients. The first trial comparing AD with lavage and sham surgery, and found there was no significant difference compared to lavage. However, when compared with sham surgery, outcomes for AD were worse at 2 weeks and not significantly different at two years. The second randomized controlled trial compared AD with arthroscopic washout and showed that AD significantly reduced knee pain at five years compared to washout. In the third randomized controlled trial there was no significant difference for AD compared to closed-needle lavage. The study was published online in the January 23, 2008, issue of the Cochrane Database of Systematic Reviews.

"There is 'gold' level evidence that AD has no benefit for undiscriminated OA,” concluded lead author Wiroon Laupattarakasem, M.D., and colleagues. "Observational studies have shown benefits for arthroscopic debridement on the osteoarthritic knee, but other recent studies have yielded conflicting results that suggest AD may not be effective.”

Knee OA begins with deterioration of the articular cartilage. Primary OA of nonspecific cause generally has slower progression versus secondary OA, which has a definite cause.
One treatment option for OA is AD, which involves irrigation to remove debris and mechanical shaving or removal of loose or misshapen parts of the joint.


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