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

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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

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