Arthroscopy for Knee Osteoarthritis in the XXI Century: a Systematic Review of Current High Quality Researches and Guidelines of Professional Societies

Cover Page

Abstract

Background. Current evidence based research data lead to reassessment of traditional approaches for treatment of patients with bone and joint disorders especially knee osteoarthritis (OA). The purpose of the study was to review randomized clinical trials (RCT) and meta-analyses of RCT as well as recent guidelines of professional societies for application of arthroscopic lavage, debridement and meniscectomy in knee OA. Materials and Methods. Databases PubMed, e-LIBRARY, EMBASE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL) were searched for the period from 2000 till 2019. From 138 heats irrelevant and poor quality studies were excluded. In total there were 1614 patients aged 48,9–62,8 in RCT and 20 770 patients aged 42–62,4 in meta-analyses of RCT. Results. Both arthroscopic lavage and debridement do not lead to significant pain relief as well as functional improvement in long term therefore are not recommended. Nonsurgical treatment should be the first line strategy in patients with early and moderate knee OA even with degenerative meniscal tears irrespective of mechanical symptoms like painful locking, catching or sudden giving way. Arthroscopy might be performed only if complex non-surgical treatment including non-steroidal anti-inflammatory drugs, structured exercises program and intra-articular injections failed after 3 months in patients without ‘bone on bone’ cartilage erosions and frontal malalignment or if the knee is mechanically locked due to bucked handle type meniscus tear or loose body. Conclusion. Evidence based medicine approach let us to conclude that arthroscopy in knee OA is non-efficient and rarely indicated therefore if proper non-surgical treatment is failed around the knee osteotomies and partial or total arthroplasty should be considered.

About the authors

A. V. Saraev

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: saraefff@mail.ru
ORCID iD: 0000-0002-9223-6330

Alexander V. Saraev — Cand. Sci. (Med.), Orthopedic Surgeon, Researcher, Knee Pathology Department

St. Petersburg

Russian Federation

T. A. Kulyaba

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: taraskuliaba@mail.ru
ORCID iD: 0000-0003-3175-4756

Taras A. Kulyaba — Dr. Sci. (Med.), Head of the Knee Pathology Department

St. Petersburg

Russian Federation

M. Sh. Rasulov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: magomed93r@yandex.ru
ORCID iD: 0000-0003-3392-1853

Magomed Sh. Rasulov — PhD Student, Orthopaedic Surgeon

St. Petersburg

Russian Federation

N. N. Kornilov

Vreden National Medical Research Center of Traumatology and Orthopedics; Mechnikov North-Western State Medical University

Email: drkornilov@hotmail.com
ORCID iD: 0000-0001-6905-7900

Nikolai N. Kornilov — Dr. Sci. (Med.), Professor, Chair of Traumatology and Orthopedics, Head of Knee Surgery Department, Vreden National Medical Research Center of Traumatology and Orthopedics; Assistant Professor, Department of Traumatology and Orthopedics, Mechnikov North-Western State Medical University

St. Petersburg

Russian Federation

References

  1. Madry H., Kon E., Condello V., Peretti G.M., Steinwachs M., Seil R. et al. Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1753-1762. doi: 10.1007/s00167-016-4068-3.
  2. Guillemin F., Ricatte C., Barcenilla-Wong A., Schoumacker A., Cross M., Alleyrat C. et al. Developing a Preliminary Definition and Domains of Flare in Knee and Hip Osteoarthritis (OA): Consensus Building of the Flare-in-OA OMERACT Group. J Rheumatol. 2019;46(9): 1188-1191. doi: 10.3899/jrheum.181085.
  3. Englund M., Guermazi A., Gale D., Hunter D.J., Aliabadi P., Clancy M. et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359(11):1108-1115. doi: 10.1056/NEJMoa0800777.
  4. Kieser C.W., Jackson R.W. Eugen Bircher (18821956) the first knee surgeon to use diagnostic arthroscopy. Arthroscopy. 2003;19(7):771-776. doi: 10.1016/s0749-8063(03)00693-5.
  5. Burman M.S. Subcutaneous Rupture of the Tendon of the Tibialis Anticus. Ann Surg. 1934;100(2):368-372. doi: 10.1097/00000658-193408000-00013.
  6. Миронова З.С. Фалех Ф.Ю. Артроскопия и артрография коленного сустава. М.: Медицина, 1982. 112 с.
  7. Kalunian K.C., Moreland L.W., Klashman D.J., Brion P.H., Concoff A.L., Myers S. et al. Visually-guided irrigation in patients with early knee osteoarthritis: a multicenter randomized, controlled trial. Osteoarthritis Cartilage. 2000;8(6):412-418. doi: 10.1053/joca.1999.0316.
  8. Gross D.E., Brenner S.L., Esformes I., Gross M.L. Arthroscopic treatment of degenerative joint disease of the knee. Orthopedics. 1991;14(12):1317-1321.
  9. Baumgaertner M.R., Cannon W.D. Jr, Vittori J.M., Schmidt E.S., Maurer R.C. Arthroscopic debridement of the arthritic knee. Clin Orthop Relat Res. 1990;(253):197-202.
  10. Yen Y.M., Cascio B., O’Brien L., Stalzer S., Millett P.J., Steadman J.R. Treatment of osteoarthritis of the knee with microfracture and rehabilitation. Med Sci Sports Exerc. 2008;40(2):200-205. doi: 10.1249/mss.0b013e31815cb212.
  11. Kirkley A., Birmingham T.B., Litchfield R.B., Giffin J.R., Willits K.R., Wong C.J. et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008;359(11):1097-1107. doi: 10.1056/NEJMoa0708333.
  12. Moseley J.B., O’Malley K., Petersen N.J., Menke T.J., Brody B.A., Kuykendall D.H. et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81-88. doi: 10.1056/NEJMoa013259.
  13. Jevsevar D.S. Treatment of osteoarthritis of the knee: evidence-based guideline, 2 nd edition. J Am Acad Orthop Surg. 2013;21(9):571-576. doi: 10.5435/JAAOS-21-09-571.
  14. Cullen K.A., Hall M.J., Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009;(11):1-25.
  15. Hamilton D.F., Howie C.R. Knee arthroscopy: influence of systems for delivering healthcare on procedure rates. BMJ. 2015;351:h4720. doi: 10.1136/bmj.h4720.
  16. Adelani M.A., Harris A.H., Bowe T.R., Giori N.J. Arthroscopy for knee osteoarthritis has not decreased after a clinical trial. Clin Orthop Relat Res. 2016;474(2):489-494. doi: 10.1007/s11999-015-4514-4.
  17. Bohensky M.A., Sundararajan V., Andrianopoulos N., de Steiger R.N., Bucknill A., Kondogiannis C.M. et al. Trends in elective knee arthroscopies in a populationbased cohort, 2000-2009. Med J Aust. 2012;197:399-403. doi: 10.5694/mja11.11645.
  18. Järvinen T.L., Guyatt G.H. Arthroscopic surgery for knee pain. BMJ. 2016;354:i3934. doi: 10.1136/bmj.i3934.
  19. Гонартроз и сходные с ним клинические состояния: клинические рекомендации. Сост. Н.Н. Корнилов. Санкт-Петербург, 2013. Режим доступа: https://mzur.ru/upload/Гонартроз.pdf
  20. Beaufils P., Becker R., Kopf S., Englund M., Verdonk R., Ollivier M., Seil R. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):335-346. doi: 10.1007/s00167-016-4407-4.
  21. British Orthopaedic Association, British Association for Surgery of the Knee. BOA/BASK response to media reports regarding knee arthroscopy. BMJ. 2015;350:h2747. Available from: www.bmj.com/content/350/bmj.h2747.
  22. Position Statement From the Australian Knee Society on Arthroscopic Surgery of the Knee, Including Reference to the Presence of Osteoarthritis or Degenerative Joint Disease: Updated October 2016. Orthop J Sports Med. 2017;5(9):2325967117728677. doi: 10.1177/2325967117728677.
  23. Zhang W., Moskowitz R.W., Nuki G., Abramson S., Altman R.D., Arden N., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137-162. doi: 10.1016/j.joca.2007.12.013
  24. National Institute for Health and Clinical Extdence. Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis (Interventional procedures guidance IPG230). 2007. Режим доступа: https://www.nice.org.uk/guidance/ipg230.
  25. Abram S.G.F., Judge A., Beard D.J., Wilson H.A., Price A.J. Temporal trends and regional variation in the rate of arthroscopic knee surgery in England: analysis of over 1.7 million procedures between 1997 and 2017. Has practice changed in response to new evidence? Br J Sports Med. 2019;53(24):1533-1538. doi: 10.1136/bjsports-2018-099414.
  26. Moseley J.B., O’Malley K., Petersen N.J., Menke T.J., Brody B.A., Kuykendall D.H. et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347:81-88. doi: 10.1056/NEJMoa013259.
  27. Herrlin S., Hållander M., Wange P., Weidenhielm L., Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):393-401. doi: 10.1007/s00167-006-0243-2.
  28. Herrlin S.V., Wange P.O., Lapidus G., Hållander M., Werner S., Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg. Sports Traumatol Arthrosc. 2013;21:358-364. doi: 10.1007/s00167-012-1960-3.
  29. Kirkley A., Birmingham T.B., Litchfield R.B., Giffin J.R., Willits K.R., Wong C.J. et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008;359(11):1097-1107. doi: 10.1056/NEJMoa0708333.
  30. Katz J.N., Brophy R.H., Chaisson C.E., de Chaves L., Cole B.J., Dahm D.L. et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-1684. doi: 10.1056/NEJMoa1301408.
  31. Sihvonen R., Paavola M., Malmivaara A., Itälä A., Joukainen A., Nurmi H. et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369:2515-2524. doi: 10.1056/NEJMoa1305189.
  32. Vermesan D., Prejbeanu R., Laitin S., Damian G., Deleanu B., Abbinante A. et al. Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears. Eur Rev Med Pharmacol Sci. 2013;17:3192-3196.
  33. Yim J.H., Seon J.K., Song E.K., Choi J.I., Kim M.C., Lee K.B. et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med. 2013;41(7):1565-1570. doi: 10.1177/0363546513488518.
  34. Gauffin H., Tagesson S., Meunier A., Magnusson H., Kvist J. et al. Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study. Osteoarthritis Cartilage. 2014;22(11):1808-1816. doi: 10.1016/j.joca.2014.07.017.
  35. Saeed K., Khan S.A., Ahmed I. Efficacy of intra articular hyaluronic acid versus arthroscopic debridement in terms of improvement in pain score in KellgranLawrence Grading II & III osteoarthritis of knee joint. Pakistan J Med Health Sci. 2015;9:1011-1015.
  36. Stensrud S., Risberg M.A., Roos E.M. Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middle-aged patients with degenerative meniscus tears: a 3-mo follow-up of a randomized controlled trial. Am J Phys Med Rehabil. 2015;94(6):460-473. doi: 10.1097/PHM.0000000000000209.
  37. Kise N.J., Risberg M.A., Stensrud S., Ranstam J., Engebretsen L., Roos E.M.. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ. 2016;354:i3740. doi: 10.1136/bjsports-2016-i3740rep.
  38. Mayr H.O., Stoehr A. [Complications of knee arthroscopy]. Orthopade. 2016;45(1):4-12. (In German). doi: 10.1007/s00132-015-3182-0.
  39. Wai E.K., Kreder H.J., Williams J.I. Arthroscopic debridement of the knee for osteoarthritis in patients fifty years of age or older: utilization and outcomes in the Province of Ontario. J Bone Joint Surg Am. 2002;84(1):17-22. doi: 10.2106/00004623-200201000-00003.
  40. Hoppener M.R., Ettema H.B., Henny C.P., Verheyen C.C., Büller H.R. Low incidence of deep vein thrombosis after knee arthroscopy without thromboprophylaxis: a prospective cohort study of 335 patients. Acta Orthop. 2006;77(5):767-771. doi: 10.1080/17453670610012962
  41. Yacub J.N., Rice J.B., Dillingham T.R. Nerve injury in patients after hip and knee arthroplasties and knee arthroscopy. Am J Phys Med Rehabil. 2009;88(8):635-641; quiz 642-644, 691. doi: 10.1097/PHM.0b013e3181ae0c9d.
  42. Jameson S.S., Dowen D., James P., Serrano-Pedraza I., Reed M.R., Deehan D.J. The burden of arthroscopy of the knee: a contemporary analysis of data from the English NHS. J Bone Joint Surg Br. 2011;93(10):1327-1333. doi: 10.1302/0301-620X.93B10.27078.
  43. Hetsroni I., Lyman S., Do H., Mann G., Marx R.G.. Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee: the incidence and risk factors in 418,323 arthroscopies. J Bone Joint Surg Br. 2011;93:47-51. doi: 10.1302/0301-620X.93B1.25498
  44. Maletis G.B., Inacio M.C., Reynolds S., Funahashi T.T. Incidence of symptomatic venous thromboembolism after elective knee arthroscopy. J Bone Joint Surg Am. 2012;94:714-720. doi: 10.2106/JBJS.J.01759.
  45. Hame S.L., Nguyen V., Ellerman J., Ngo S.S., Wang J.C., Gamradt S.C. Complications of arthroscopic meniscectomy in the older population. Am J Sports Med. 2012;40:1402-1405. doi: 10.1177/0363546512443043.
  46. Yeranosian M.G., Petrigliano F.A., Terrell R.D., Wang J.C., McAllister D.R. Incidence of postoperative infections requiring reoperation after arthroscopic knee surgery. Arthroscopy. 2013;29:1355-1361. doi: 10.1016/j.arthro.2013.05.007.
  47. Bohensky M.A., Ademi Z., deSteiger R., Liew D., Sundararajan V., Bucknill A. et al. Quantifying the excess cost and resource utilisation for patients with complications associated with elective knee arthroscopy: a retrospective cohort study. Knee. 2014;21(2):491-496. doi: 10.1016/j.knee.2013.11.009.
  48. Basques B.A., Gardner E.C., Varthi A.G., Fu M.C., Bohl D.D., Golinvaux N.S. et al. Risk factors for short-term adverse events and readmission after arthroscopic meniscectomy: does age matter?. Am J Sports Med. 2015;43(1):169-175. doi: 10.1177/0363546514551923.
  49. Krych A.J., Sousa P.L., Morgan J.A., Levy B.A., Stuart M.J., Dahm D.L. Incidence and risk factor analysis of symptomatic venous thromboembolism after knee arthroscopy. Arthroscopy. 2015;31(11):2112-2118. doi: 10.1016/j.arthro.2015.04.091.
  50. Cancienne J.M., Gwathmey F.W., Werner B.C. Intraoperative corticosteroid injection at the time of knee arthroscopy is associated with increased postoperative infection rates in a large medicare population. Arthroscopy. 2016;32(1):90-95. doi: 10.1016/j.arthro.2015.09.003.
  51. Материалы международной согласительной конференции по перипротезной инфекции: пер. с англ.; под ред. Р.М. Тихилова – СПб.: РНИИТО им. Р.Р. Вредена, 2014. 355 с.
  52. Lubowitz J.H., Ayala M., Appleby D. Return to activity after knee arthroscopy. Arthroscopy. 2008;24:58-61. doi: 10.1016/j.arthro.2007.07.026.
  53. Pihl K., Roos E.M., Nissen N. et al. Overoptimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery. Acta Orthop. 2016;87(6):615-621. doi: 10.1080/17453674.2016.1228411.
  54. Katz J.N., Jones M.H. Treatment of meniscal tear: the more we learn, the less we know. Ann Intern Med. 2016;164:503-504. doi: 10.7326/M16-0049
  55. Slomski A. Surgery no benefit to patients with meniscal tears. JAMA. 2016;316(12):1250. doi: 10.1001/jama.2016.12223.
  56. Buchbinder R. Meniscectomy in patients with knee osteoarthritis and a meniscal tear? N Engl J Med. 2013;368(18):1740-1741. doi: 10.1056/NEJMe1302696.
  57. Lohmander L.S., Thorlund J.B., Roos E.M. Routine knee arthroscopic surgery for the painful knee in middle-aged and old patients — time to abandon ship. Acta Orthop. 2016;87:2-4. doi: 10.3109/17453674.2015.1124316.
  58. Gandhi R., Perruccio A.V., Kakar S., Haddad F.S. Putting the baby back in the bathwater: the interpretation of randomised trials in surgery. Bone Joint J. 2015;97B(11):1456-1457. doi: 10.1302/0301-620X.97B11.36981.
  59. Liebs T.R., Ziebarth K., Berger S. Randomized controlled trials for arthroscopy in degenerative knee disease: was conservative therapy appropriately tried prior to arthroscopy? Arthroscopy. 2018;34(5):1680-1687.e6. doi: 10.1016/j.arthro.2017.12.016.
  60. Stone J.A., Salzler M.J., Parker D.A., Becker R., Harner C.D. Degenerative meniscus tears — assimilation of evidence and consensus statements across three continents: state of the art. J ISAKOS Joint Disord Orthop Sport Med. 2017;2(2):108-119. Avialable from: http://dx.doi.org/10.1136/jisakos-2015-000003.
  61. Bollen S.R. Is arthroscopy of the knee completely useless? Meta-analysis − a reviewer’s nightmare. Bone Joint J. 2015;97-B:1591-1592. doi: 10.1302/0301-620X.97B12.37456.
  62. Price A.J., Haddad F.S., Beard D.J. New guidelines for the use of arthroscopic meniscal knee surgery. Bone Joint J. 2019;101-B(6):625-626. doi: 10.1302/0301-620X.101B6.BJJ-2019-0550.
  63. Siemieniuk R.A.C., Harris I.A., Agoritsas T., Poolman R.W., Brignardello-Petersen R., Van de Velde S. et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. Br J Sports Med. 2018;52(5):313. doi: 10.1136/bjsports-2017-j1982rep.
  64. Abram S.G.F., Beard D.J., BASK Meniscal Working Group. Arthroscopic meniscal surgery: a national society treatment guideline and consensus statement. Bone Joint J. 2019;101-B(6):652-659. doi: 10.1302/0301-620X.101B6.BJJ-2019-0126.R1.
  65. Kumm J., Roemer F.W., Guermazi A., Turkiewicz A., Englund M. Natural History of Intrameniscal Signal Intensity on Knee MR Images: Six Years of Data from the Osteoarthritis Initiative. Radiology. 2016;278(1):164-171. doi: 10.1148/radiol.2015142905.
  66. Sun Y., Mauerhan D.R., Kneisl J.S., James Norton H., Zinchenko N. et al. Histological examination of collagen and proteoglycan changes in osteoarthritic menisci. Open Rheumatol J. 2012;6:24-32. doi: 10.2174/1874312901206010024.
  67. Zanetti M., Pfirrmann C.W., Schmid M.R., Romero J., Seifert B., Hodler J. Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. AJR Am J Roentgenol. 2003;181(3):635-641. doi: 10.2214/ajr.181.3.1810635.
  68. Brian D., Mackenzie W.G., Shim S.S., Leung G. (1985) The vascular and nerve supply of the human meniscus. Arthroscopy. 1985;1(1):58-62. doi: 10.1016/s0749-8063(85)80080-3.
  69. Sihvonen R., Englund M., Turkiewicz A., Järvinen T.L.. Finnish Degenerative Meniscal Lesion Study Group. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: a secondary analysis of a randomized trial. Ann Intern Med. 2016;164:44955. doi: 10.7326/M15-0899.
  70. Englund M., Guermazi A., Roemer F.W., Yang M., Zhang Y., Nevitt M.C. et al. Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST Study. Ann Rheum Dis. 2010;69(10):1796-802. doi: 10.1136/ard.2009.121681.
  71. Scher C., Craig J., Nelson F. Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up. Skeletal Radiol. 2008;37(7):609-617. doi: 10.1007/s00256-008-0504-x.
  72. De Smet A.A., Graf B.K., del Rio A.M. Association of parameniscal cysts with underlying meniscal tears as identified on MRI and arthroscopy. AJR Am J Roentgenol. 2011;196(2):W180-186. doi: 10.2214/AJR.10.4754.

Statistics

Views

Abstract: 360

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies