Arthroscopic Treatment of Osteoarthritis of the Knee
Are There Any Evidence-based Indications?
Patrick Siparsky, BS*; Mark Ryzewicz, MD†; Bret Peterson, BS*; and Reed Bartz, MD‡
Despite the lack of consensus guidelines and randomized control trials, the use of arthroscopy for thetreatment of osteoarthritis of the knee has increased over the last decade. Techniques used for the arthroscopic treatment of osteoarthritis of the knee include joint lavage, joint débridement, meniscectomy, abrasion arthroplasty, and microfracture. We performed a retrospective, evidence-based review of the current literature on the arthroscopic treatment of osteoarthritis of the knee and provideinsight into the study design flaws and difficulties associated with the current research on this controversial topic. Our literature search yielded 18 relevant studies. Of these, one was Level I evidence, five were Level II, six were Level III, and six were Level IV. We found limited evidence-based research to support the use of arthroscopy as a treatment method for osteoarthritis of the knee.Arthroscopic débridement of meniscus tears and knees with low-grade osteoarthritis may have some utility, but it should not be used as a routine treatment for all patients with knee osteoarthritis. Level of Evidence: Level IV, systematic review. See Guidelines for Authors for a complete description of levels of evidence.
In the past 10 years, substantial attention has been called to the value ofarthroscopic treatment of osteoarthritis (OA).4 Currently, there is no consensus on the appropriateness of arthroscopy in the treatment of OA of the knee. One reason for the continued controversy is the lack of sufficient Level I investigations including randomized control trials
From the *University of Colorado School of Medicine and the †Department of Orthopedic Surgery, University of Colorado HealthScience Center, Denver, CO; and the ‡Nebraska Orthopaedic and Sports Medicine, Lincoln, Nebraska. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Correspondence to: Reed L. Bartz, MD, Nebraska Orthopaedic andSports Medicine, PC St. Elizabeth Medical Plaza, 575 S. 70th Street, Suite 200, Lincoln, NE 68510. Phone: 402-488-3322; Fax: 402-488-1172; E-mail: email@example.com. DOI: 10.1097/BLO.0b013e31802fc18c
and prospective studies, which would accurately assess the value of arthroscopy as a treatment modality for OA. This is largely the result of the difficulty in designing an adequate studyby which to evaluate this technique. Most published studies investigating the effectiveness of arthroscopic treatment of knee OA are limited because of shortterm followup,10,11 lack of randomization or a control group,1,3,9–12,15 or inconsistent methods of assessing and separating varying degrees of arthritis severity.13,15,16 Ethical considerations make blinding this type of surgical procedurecomplicated, and hence many reports are simply large case series providing information about the results of arthroscopy performed by a surgeon or several surgeons. Several recently published studies evaluate various treatment modalities for OA including arthroscopic intervention.7,11 Many studies compare two or more types of treatment; however, we found only one study with a control group.17Additionally, many studies investigate the effectiveness of surgical intervention with varying degrees of OA, but do not have stratified results comparing the different treatment groups in relation to the severity of the OA. These and other problems are evaluated here to highlight some of the clinically useful and nonuseful measures in treatment of OA with arthroscopy. The goal of this review is to...