Preliminary results with abrasion arthroplasty in the osteoarthritic knee

A retrospective survey of 110 patients treated by arthroscopic debridement of the knee joint was conducted; 73 of 100 operations included abrasion arthroplasty. The average follow-up period was one year. All patients had Grade IV articular changes. Overall, 60% of the patients who underwent abrasion arthroplasty showed improvement, while the knee was unchanged in 34% and worse in 6%. The results were best in patients younger than 40 years of age. Forty-one patients had medial compartment abrasion in concert with pathologic medial meniscal conditions; 53% of these patients were improved. In a comparable group of 37 patients treated by medial compartment debridement and medial meniscectomy without abrasion only 32% showed improvement. Thus, tentative results in this small series of patients treated by abrasion arthroplasty are encouraging. Further investigations in a larger series are warranted to determine the long-term results of the procedure.     

The arthroscopic treatment of unicompartmental gonarthrosis: a five-year follow-up study of abrasion arthroplasty plus arthroscopic debridement and arthroscopic debridement alone

A retrospective review with a mean follow-up time of 60 months was performed on 126 patients who had treatment of unicompartmental gonarthrosis with either abrasion arthroplasty plus arthroscopic debridement or arthroscopic debridement alone. Fifty-nine patients had abrasion arthroplasty and arthroscopic debridement, and 67 patients had arthroscopic debridement alone. All patient had stage II Ahlb?ck changes roentgenographically, as well as Outerbridge stage IV changes arthroscopically in the involved compartment. All the knees were evaluated postoperatively at a minimum of 60 months, utilizing The Hospital For Special Surgery Knee Scoring System. In the group treated with abrasion arthroplasty, 51% had good to excellent results, 16% had fair results, and 33% had poor results. The conditions of ten of the patients who had poor results actually became worse subsequent to their abrasion arthroplasty. In the group that had arthroscopic debridement, 66% had good to excellent results, 13% had fair results, and 21% had poor results. The conditions of 12 of the patients who had poor results actually became worse subsequent to the arthroscopic debridement.     

Arthroscopic debridement for grade III and IV chondromalacia of the knee in patients older than 60 years

Arthroscopic debridement has been used to treat patients with degenerative knee osteoarthritis, although there is sometimes conflicting evidence documenting its efficacy. This study evaluates the success of arthroscopic debridement in elderly patients with grade III and IV chondromalacia of the knee as measured by patient satisfaction and the need for additional surgery. From December 1998 to August 2001, a total of 102 consecutive cases of knee arthroscopy in 99 patients > 60 years were performed. Average follow-up was 34 months (range: 7-104 months). Patients were asked about their satisfaction using a visual analog scale, and the presence of meniscal lesions during arthroscopy and the treatment for these lesions were evaluated. Knees also were assessed for articular surface degeneration using Outerbridge's classification for chondromalacia. The need for and type of additional surgery was evaluated. During arthroscopy, meniscal lesions requiring a partial meniscectomy were found in 95 knees. Chondromalacia was found in 92 knees; 53 knees had grade I or II chondromalacia and 39 knees had grade III or IV chondromalacia. Additional surgery was performed in 17 knees. Mean patient satisfaction score was 73 (range: 50-100) in the 39 knees with grade III or IV chondromalacia after arthroscopic debridement was performed. These findings suggest arthroscopic debridement in elderly patients has a place in the treatment algorithm for grade III or IV chondromalacia of the knee.     

Arthroscopic partial medial meniscectomy in patients over 40 years old: A 5- to 11-year follow-up study

A retrospective analysi sof 68 knees from 65 patients older than 40 years, who had undergone a partial medial meniscectomy, was carried out. The average age of the patients was 49.7 years (range, 40 to 74), and themean follow-up period was 7.8 years (range, 5 to 11). The patients were divided into two groups based on the degree of articular cartilage degeneration. Group I consisted of 53 knees that did not have any significant articular cartilage damage beyond grade I or II. Group II consisted of 15 knees that had grade III or IV cartilage damage. Overall, excellent results were obtained in 44 patients (47 knees), good results in 10 patients, fair results in six patients, and poor results in five patients. In group I, 46 knees (87%) had an excellent outcome, and only one patient had a poor result. In contrast, patients in group II had significantly worse results, with only one knee (7%) having excellent outcome, and four knees had a poor result. A specific history of trauma did not affect the clinical outcome. Forty-two patiens (64%) were able to resume normal athletic activities without any restrictions. Arthroscopic partial medial meniscectomy in patients older than 40 years is an acceptable and effective long-term treatment, particularly in patients without significant articular cartilage damage.     

Knee arthroscopy in the older patient

With seniors living longer, more active, healthier lives, arthroscopy in the senior knee has become a commonlyperformed orthopaedic procedure., Because of the favorable risk-benefit ratio of arthroscopy when compared with more invasive procedures such as arthroplasty or osteotomy, the procedure is often offered as a temporizing measure to patients in whom it may be of only short-term benefit. Appropriate patient selection is imperative to a successful outcome. Based on currently available data, the following patient variables can be associated with favorable postoperative outcomes: normal roentgenographic limb alignment, history of mechanical symptoms, minimal or no roentgenographic signs of degeneration, short duration of symptoms, and no previous surgery. With minimal associated morbidity, it appears that arthroscopic lavage may be considered as a palliative treatment option for osteoarthritic knees; however, results deteriorate over time. Preexisting degenerative articular changes, not age, have often been reported as the most important predicting factor for the outcome following arthroscopic partial meniscectomy in the elderly. Although the results of arthroscopic partial meniscectomy are poorer in patients with significant degenerative joint disease, the results appear to be acceptable in the short term. In active seniors with mild degenerative knee arthritis, conservative arthroscopic debridement is the initial procedure of choice after a nonoperative regimen has failed. Because of its unpredictability, high failure rate, and prolonged rehabilitation phase, abrasion arthroplasty has fallen out of favor as a primary treatment for degenerative arthritis of the knee in the older, active patient.     

Debridement arthroscopy. 10-year followup.

The treatment of osteoarthritis of the knee is a difficult problem. In the senior author's opinion, nonaggressive arthroscopic debridement of the knee is an effective procedure to relieve pain and restore function in patients with osteoarthritis of the knee. A subjective telephone interview of patients done 10 or more years after arthroscopic debridement evaluated the long term results of this treatment in patients with osteoarthritis of the knee. The patients all were candidates for total knee replacement who selected arthroscopy as a temporizing procedure. Of the 191 knees in patients undergoing arthroscopic debridement, 77 patients (91 knees) were contacted for followup. Sixty-seven percent of the 91 knees did not have total knee arthroplasty at an average of 13.2 years followup. The Tegner activity score averaged 3.5 and patient satisfaction averaged 8.6 on a 0 to 10 scale. Twenty-one patients (30 knees) or (33%) had total knee arthroplasty at an average of 6.7 years. Seven of these had total knee arthroplasty within 2 years of arthroscopic debridement. Six of these seven knees had Outerbridge Grade 4 articular cartilage changes and clinically significant meniscus tears. Seven of the 19 knees (37%) with Outerbridge Grade 4 changes in 80% of one knee compartment did not require total knee arthroplasty after greater than 10 year followup. The difficulties in long term followup in this patient population is evident, yet the number of patients who had a functional lifestyle after arthroscopic debridement was notable.     

Arthroscopic management of degenerative meniscus tears in patients with degenerative arthritis

Frequently, meniscal pathology accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears, usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty-seven knees in 84 patients were studied. The mean age was 62 (29-84) years. The right knee was involved in 44 patients, and 47 were men. Preoperative radiographs demonstrated osteoarthritis in 53 patients. The medial meniscus was involved in 82, while the lateral meniscus was affected in nine knees. Four knees had involvement of both menisci. In 72 knees, the most frequent lesion was a tear of the posterior horn of the medial meniscus. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 +/- 13 (mean +/- SD) days. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper-tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. Subchondral sclerosis or osteophytes on the preoperative radiographs correlated with 72% compared to 90% satisfactory results in the absence of these findings (p less than 0.03). Complications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Outcome of arthroscopic meniscectomy a 13-year physical and radiographic follow-up of 43 patients under 23 years of age

We reexamined 43 patients with stable knees at a mean of 13 years after arthroscopic meniscectomy. The patients had a maximum age of 22 years at the operation and no patient had had previous surgery on the involved knee. At the follow-up examination, no differences in range of motion, muscle strength or tibial A/P displacement were seen between the operated and the nonoperated knees and 36 patients had no problem with their knee in daily life. Radiographic changes were found in the operated knee in 20 patients and in the nonoperated knee in 5 patients. 8 patients had a reduction of the joint space on the involved side, but none had more severe changes. Cartilage fibrillation at the index arthroscopy did not increase the radiographic changes at follow-up, but radiographic changes were commoner after subtotal meniscectomy (7/8) than after partial meniscectomy (17/35). These findings are similar to previous studies of arthroscopic meniscectomy of medium duration and do not differ considerably from studies of open meniscectomy.     

1310例侧膝关节半月板损伤关节镜下诊治效果分析

目的　分析关节镜下半月板损伤不同修复方法的效果 ,提出半月板损伤修复较适用方法。方法　随访 1310例侧膝关节半月板损伤镜下修复的患者 ,从发病年龄、损伤类型、镜下修复方法及效果进行分析 ,其中男性 880例 (90 9例侧 ) ,女性 374例 (4 0 1例侧 ) ,平均 2 5 5岁 ,平均患病时间半年。半月板缝合 6 8例侧 ,部分切除成形术 75 6例侧 ,半月板全切除 4 80例侧 ,6例儿童半月板损伤镜检确定后未行镜下处理 ,于镜检后石膏固定。结果　术后平均随访 4年 3个月 ,Lysholm评分 :半月板缝合术前 4 7 5分 ,术后 86 3分 ;半月板部分切除成形术前 4 5 1分 ,术后 84 0分 ;半月板全切除术前4 5 4分 ,术后 76 1分。 6例少年儿童半月板损伤 ,Lysholm评分术前 4 5 0分 ,术后 98 7分。三种治疗方法效果有显著性差异 (t=2 876 ,P <0 0 1)。结论　半月板损伤应在关节镜下行缝合或部分切除成形治疗 ,避免半月板切除 ;<14岁盘状半月板损伤需部分切除成形 ,半月板损伤非手术治疗可获得较好疗效     

The effect of alignment on results in arthroscopic debridement of the degenerative knee

Fifty-two patients with severe degenerative joint disease of the knees were treated by arthroscopic debridement. The results of arthroscopic debridement on normally aligned degenerative knees are encouraging. A combination of arthroscopic debridement and high tibial osteotomy could be an appealing alternative to total knee arthroplasty in the young patients. Patients with varus angular deformity in the degenerative knee had a poor result and should be excluded from consideration for arthroscopic debridement.     

膝关节骨性关节炎的分型和关节镜视下治疗

对４６例５１个膝关节的骨性关节炎进行了分型和关节镜视下治疗。为了治疗针对性强，将本病分为５型，髌股关节型，胫股内侧间隔型，胫股外侧间隔型，胫股全关节型和全膝关节型，主要治疗包括冲洗，增生滑膜刨除，关节面修整，软骨缺损处钻孔，平均随访４．１年优良率８６．６％，滑膜挤夹，嵌顿为本病疼痛的主要原因。骨赘在影响关节活动或有脱落危险时才切除。     

关节镜下清理和钻孔治疗膝关节软骨退变的疗效分析

目的探讨关节镜下清理和钻孔治疗膝关节软骨退变的临床疗效。方法 2009年1月至2013年2月,87例膝关节软骨退变患者随机分为两组,A组含45例(56侧),予关节镜下清理术治疗;B组含42例(51侧),行关节镜下清理+软骨下骨钻孔术,术后予对症治疗。观察两组患者治疗后的效果。结果 A组治疗后6个月时优良率为64.29%,B组6个月后优良率为84.31%,差异有统计学意义(P<0.01)。两组患者术后均随访2年,B组术后6个月、1年和2年的优良率分别为89.29%、80.36%和75.00%,术后2年时的疗效显著低于6个月时(P=0.04)。结论关节镜清理+钻孔术治疗膝关节软骨退变疗效优于单纯关节镜清理术,但其疗效随时间延长而降低。     

Treatment of the anterior cruciate ligament-absent knee with associated meniscal tears. Instrumented testing and clinical evaluation of two patient groups

The UCLA instrumented clinical testing apparatus was used to measure postoperative stiffness and laxity for two groups of patients with documented chronic absence of the anterior cruciate ligament (ACL) and associated meniscal tears. Group 1 consisted of 76 patients (average age, 25 years) who had undergone anterior cruciate substitution using the torn meniscus, and a second group of 34 patients (average age, 31 years) who had partial meniscectomy alone without ACL substitution. Subjective and objective evaluations were significantly higher and symptoms of pain and buckling significantly lower in the substitution group. In addition, 29% of Group 1 and only 7% of Group 2 patients were able to return to their preinjury sports without limitations, while 5% of the former and 12% of the latter could not return to any sport. At 90 degrees of flexion, there were no significant differences in stiffness or laxity between the patient groups. At 20 degrees of flexion and neutral foot rotation, the meniscal substitution group had an average of 1.4 mm less side-to-side laxity difference than the partial meniscectomy patients; 51% of the substituted patients still had an injured knee laxity that was at least 2 mm greater than the uninjured knee, as contrasted to 67% of the partial meniscectomy patients who exceeded this upper limit of the normal range. At 20 degrees, anterior stiffness of the injured knees of the substitution patients was 28% greater than the injured knees of the partial meniscectomy group; 42% of the substituted patients had an injured knee stiffness within the normal range, while only 18% of the partial meniscectomy patients fell within normal limits. There were no statistical correlations of stiffness or laxity values with clinical scores or patient symptomatology in either group.     

Atraumatic osteonecrosis of the knee

BACKGROUND: The purposes of this study were to define the clinical, demographic, and radiographic patterns of atraumatic osteonecrosis of the distal part of the femur and the proximal part of the tibia at presentation and to report the outcome of treatment of this condition. METHODS: Two hundred and forty-eight knees in 136 patients who were younger than the age of fifty-five years were treated at our institution between July 1, 1974, and September 15, 1998, for atraumatic osteonecrosis of the distal part of the femur or the proximal part of the tibia, or both. Demographic and radiographic features were characterized. The results of nonoperative treatment, core decompression, arthroscopic debridement, and total knee arthroplasty were evaluated. RESULTS: There were 106 female patients and thirty male patients, and their mean age was thirty-six years (range, fifteen to fifty-four years) at the time of diagnosis. One hundred and one patients (74 percent) had involvement of other large joints, with eighteen (13 percent) presenting initially with knee symptoms. One hundred and one patients (74 percent) had a disease that affected the immune system; sixty-seven of them had systemic lupus erythematosus. One hundred and twenty-three patients (90 percent) had a history of corticosteroid use. Technetium-99m bone-scanning missed lesions in sixteen (29 percent) of fifty-six knees. Eight (20 percent) of forty-one initially symptomatic knees treated nonoperatively had a successful clinical outcome (a Knee Society score of at least 80 points and no additional surgery) at a mean of eight years. The knees that remained severely symptomatic for three months were treated with either core decompression (ninety-one knees) or total knee arthroplasty (seven knees). Seventy-two (79 percent) of the ninety-one knees treated with core decompression had a good or excellent clinical outcome at a mean of seven years. Efforts to avoid total knee arthroplasty with repeat core decompression or arthroscopic debridement led to a successful outcome in fifteen (60 percent) of twenty-five knees. Thirty-four (71 percent) of forty-eight knees treated with total knee arthroplasty had a successful clinical outcome at a mean of nine years. CONCLUSIONS: Atraumatic osteonecrosis of the knee predominantly affects women, and in our study it was associated with corticosteroid use in 90 percent of the patients. Evaluation should include standard radiographic and magnetic resonance imaging of all symptomatic joints. Prognosis was negatively related to large juxta-articular lesions. Nonoperative treatment should be reserved for asymptomatic knees only. Core decompression was successful (a Knee Society score of at least 80 points and no additional surgery) in 79 percent of the knees in which the disease was in an early stage. Total knee arthroplasty was successful in only 71 percent of the knees.     

Fifteen-year follow-up of arthroscopic partial meniscectomy

From an original pool of 283 patients, 146 patients who had undergone arthroscopic partial meniscectomy an average of 14.7 years before were followed-up. Lysholm score, Tegner activity level, satisfaction index on a scale of 1 to 10, and standing anteroposterior and flexion weight-bearing radiographs of both knees, were obtained. A physical examination was performed on each knee emphasizing motion, swelling, and ligament evaluation. Radiographs were graded for degenerative changes for each knee. Each knee joint space was also measured in millimeters and compared, operative knee with unoperated knee. The unoperated knee had no injuries or surgeries and was used as a control. Patients were 83% male and 17% female; 78% had undergone medial meniscectomies, 19% lateral, and 3% both. There were 88% good and excellent results in anterior cruciate liagment—stable knees. The radiographic grade side-to-side difference showed the operative knee to be only a 0.23 grade worse than the nonoperative knee. Age at the time of meniscectomy was not found to be a factor. Male patients had better radiographic results than female patients, but not better functional scores. Medial meniscus and lateral meniscus results were not significantly different. Knees with a femoral-tibial anatomic alignment of >0° valgus compared with ≤0° and that had undergone medial meniscectomy had significantly better radiographic results. Patients with anterior cruciate ligament tears and meniscectomy did significantly poorer than stable knees with meniscectomy in regards to radiographic grade change, Lysholm, satisfaction index, Tegner level, and medial joint space narrowing.     

Problems with cementless total knee arthroplasty at 11 years followup.

One hundred two patients with 131 consecutive cementless total knee arthroplasties that retained the posterior cruciate ligament were followed up prospectively. The average age of the patients was 58 years (range, 32-75 years). The mean followup on the surviving knee arthroplasties was 11 years (range, 7-16 years). The patellar component was metal-backed in the first 112 (85%) knees, cementless all-polyethylene in the last 17 (13%) knees, and two knees had a prior patellectomy. Forty-four metal-backed patellar components (48%) were revised; nine were loose, and 35 had polyethylene wear through. Thirteen femoral components (12%) were revised because of femoral abrasion from a failed metal-backed patellar component. No other femoral component was revised, loose, or had osteolysis develop. Nine (8%) tibial components had failure of ingrowth; eight have been revised. Partial radiolucencies occurred in 53% of the tibias. Thirteen (12%) small osteolytic lesions developed, all around screws or screw holes in the tibial components. At an average of 11 years followup, cementless fixation yielded mixed results: cementless femoral fixation was excellent and metal-backed patellar components had a 48% patellar revision rate. Cementless tibial components had an 8% aseptic loosening rate and a 12% incidence of small osteolytic lesions. Based on these results, the authors have abandoned cementless fixation in total knee arthroplasty.     

Arthroscopic Treatment of Patellar Clunk and Synovial Hyperplasia After Total Knee Arthroplasty

Patellofemoral pain, crepitus, and locking are infrequent symptoms after total knee arthroplasty (TKA). We performed a retrospective review of 25 patients who underwent arthroscopic debridement after primary TKA to treat the patellar clunk syndrome (15 knees) or patellofemoral synovial hyperplasia (10 knees). After surgery, patient-reported knee pain and crepitus as well as Knee Society knee and function scores improved in both groups. Postoperative knee range of motion remained unchanged. Arthroscopic debridement of symptomatic patellofemoral synovium after TKA is a safe and effective procedure.     

Arthroscopic medial meniscectomy on stable knees

We reviewed 74 partial medial meniscectomies in 57 patients with stable knees, to assess the long-term functional and radiological outcome. The International Knee Documentation Committee score and the residual laxity were assessed in both knees. At the time of surgery the mean age of the patients was 36 +/- 11 years and the mean follow-up was 12 +/- 1 years. All had a limited medial meniscectomy. The anterior cruciate ligament was intact in all cases. The meniscal tear was vertical in 95% and complex in 5%. The posterior part of the meniscus was removed in 99%. A peripheral rim was preserved in all cases. After 12 years 95% of the patients were satisfied or very satisfied with their knee(s). Objectively, 57% had grade A function and 43% were grade B. The outcome correlated only with the presence of anterior knee pain at final follow-up. In the 49 cases of arthroscopic meniscectomy for which there was a contralateral normal knee there was narrowing of the 'joint-space' in 16% of the operated knees. There was no correlation between this and other parameters such as age or different meniscal pathologies.     

The effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: a retrospective review of functional,clinical, and radiographic results

A retrospective review of patients who underwent arthroscopic partial lateral meniscectomy for lateral meniscus tears in otherwise normal knees was conducted to review the long-term functional, clinical, and radiographic results. Twenty-six patients (27 knees) were evaluated by questionnaire; 20 patients (21 knees) also underwent physical examination and radiographic analysis. Minimum follow-up was 5 years and mean follow-up was 8 years. Patient data were obtained from detailed questionnaires, knee examinations, and radiographs. Excellent or good results decreased from 92% at the time of maximal improvement to 62% at the most recent follow-up: 85% of patients were initially able to return to their preinjury activity level; however, only 48% were able to maintain this level of activity at the most recent follow-up. Seventy-two percent of patients had either one or no Fairbank changes and there was no statistical difference when comparing radiographic criteria in the operated and nonoperated knee. Early results for partial lateral meniscectomy can be quite good; however, significant deterioration of functional results and decreased activity level can occur. Radiographic changes did not correlate with subjective sumptoms and functional outcome in our patient population. Our findings suggest that the functional outcome for patietns undergoing partial lateral meniscectomy may deteriorate with time and it may be helpful to counsel patients concerning long-term expectations.     

Hypertrophy of the synovium in the anteromedial aspect of the knee joint following trauma: An unusual cause of knee pain

Purpose: The purpose of this study was to describe the arthroscopic clinical findings and treatment in patients with pathologic hypertrophy of the synovium in the anteromedial joint compartment in conjunction with anteromedial knee pain. Type of Study: Case series. Methods: A group of 21 patients, ranging in age from 11 to 68 years (mean, 29 years) with pathologic hypertrophic changes of the synovium in the anteromedial joint compartment were studied. Pathologic changes included inflammation, polyp-type appearances, or hypertrophic string forming a loop. The most significant clinical finding was pain in the anteromedial aspect of the knee joint. Of the 21 cases, 20 (95%) had a history of trauma to the involved knee. Assessments performed included Lysholm knee scores with a special emphasis on knee pain. The duration of symptoms ranged from 2 to 32 months (mean, 13 months). Treatment consisted of an arthroscopic evaluation followed by debridement of the hypertrophic synovium using a laser, shaver, or thermal debrider. Results: The mean follow-up was 5.1 years (1.2 to 10 years). Mean Lysholm score improved from 64.1 to 96.4 (P < .05). Specifically, the pain score improved from 4.3 to 23 (P < .05). All patients were free of pain within 3 weeks following arthroscopic debridement. Return to normal function, including sports, was achieved for all patients within 2 months. Arthroscopic evaluation revealed that 18 of 21 (86%) knees had mild chondral damage on the medial femoral condyle, grade I or II according to Outerbridge grading. Conclusions: Based on the clinical and arthroscopic findings, we concluded that pathologic hypertrophy of the synovium in the anteromedial joint compartment may result following trauma, causing mild chondromalacia changes in the medial femoral condyle and knee pain. Arthroscopic debridement of this pathologic tissue significantly improves symptoms.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 735–740