A clinically and arthroscopically oriented staging system based on the severity of the degenerative process has been used in the assessment of the results of arthroscopic lavage and debridement of osteoarthritic (OA) knees.
Retrospective case series.
For eighteen months, commencing January 1995, every case of previously untreated OA referred for definitive treatment was clinically classified into 1 of 4 stages of increasing degeneration. Excluded were patients who were treated nonoperatively, by replacement arthroplasty or marrow stimulation techniques. A group of 121 cases treated by arthroscopic lavage and debridement were available for review with a 4 to 6 year follow-up.
Arthroscopic lavage and debridement carried out in the earlier stages of the degenerative process resulted in significant relief of symptoms for reasonably long periods of time. The more advanced stages of degeneration commonly experienced some temporary relief from arthroscopic lavage and debridement, but the amount of improvement was unpredictable.
The surgeon's armamentarium for the treatment of degenerative arthritis unresponsive to conservative treatment methods should involve minimal interventional arthroscopy at an earlier, rather than a later stage in the disease process. It is recommended that the arthroscopist be conservative in the surgical debridement, removing only the fibrillated and scaling fragments of articular cartilage.