ARthroscopy in Knee OsteoArthritis (ARK-OA): a multicentre study assessing compliance to national guidelines

Khatri, Chetan; Dickenson, Edward; Ahmed, Imran; Bretherton, Chris; Ranaboldo, Tom; Shaw, Colin N.; Quarcoopome, Jared; Plastow, Ricci; Downham, Christopher; Rasidovic, Damir; Plant, Caroline Elizabeth; Barlow, Timothy

doi:10.1007/s00590-021-02905-5

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…Nevertheless, many patients are still referred for a MRI or knee arthroscopy for symptomatic degenerative knee complaints [8, 12, 15, 16, 22, 24–26, 30, 35, 42, 44]. Smith et al [41] showed that in Australia knee MRI rates for patients aged 55 years and older increased from 216 per 100 000 to 1509 per 100 000 in 2017.…”

Section: Introductionmentioning

confidence: 99%

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Rietbergen

Mheen

Graaf

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). Methods All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. Results 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). Conclusions The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. Level of evidence III.

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Section: Introductionmentioning

confidence: 99%

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Rietbergen

Mheen

Graaf

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…8 Besides a non-coverage Medicare determination was made in United States in 2014, 27 some national or professional society guidelines were implemented for the same purpose in other country. [28][29][30][31][32] Our report might shed some light on the confusing and negative impression about arthroscopic treatment for knee OA. Unlike the uncertain beneficial mechanism and the diverse outcomes of common arthroscopic techniques including lavage, debridement, abrasion arthroplasty, microfracture, and autologous chondrocyte implantation (ACI) for knee OA, the concept of ACRFP has precise rationale of treatment and more beneficial, reproducible outcomes.…”

Section: Discussionmentioning

confidence: 72%

Arthroscopic cartilage regeneration facilitating procedure can modify the clinical course of knee osteoarthritis

Lyu

Hsu²,

Hung³

et al. 2023

J Orthop Surg (Hong Kong)

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Background The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been controversial. This study compares the clinical outcomes of the arthroscopic cartilage regeneration facilitating procedure (ACRFP) and conservative treatment. Methods During the year of 2016, 524 patients (882 knees) who were older than 40 years of age and diagnosed with different stages of knee OA were scheduled for ACRFP under the protocol of knee health promotion option (KHPO) for knee OA. Of those, 259 patients (413 knees) eventually received ACRFP (the ACRFP group), and 265 patients (469 knees) didn’t receive ACRFP but received conservative treatment (the non-ACRFP group). A telephone questionnaire was used to evaluate the subjective satisfaction and the incidence of receiving arthroplasty for these patients. Results After the mean follow-up period of 61.6 months (SD 4.5), there were 220 patients (374 knees, 90.6%) in the ACRFP group and 246 patients (431 knees, 90.0%) in the non-ACRFP group completed the outcome study. The satisfactory rate was statistically higher for the ACRFP group (90.64%) than for the non-ACRFP group (70.3%) and the difference in subjective satisfaction was more obvious in patients with more advanced knee OA. As for the incidence of patients having subsequently received arthroplasty, it was higher (13.46%) in the non-ACRFP group than in the ACRFP group (4.28%). Conclusion Compared with conservative treatment, ACRFP could satisfy more patients with knee OA and modify their natural course by decreasing the incidence of subsequent arthroplasty.

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“…The primary method of diagnosing OA is imaging examination, which mainly includes X-rays, computed tomography (CT), MRI, ultrasonography, and arthroscopy. X-ray examination is one of the preferred methods for the clinical diagnosis of OA[ 19 , 20 ]. It can detect key features of OA, such as joint space narrowing, osteophytes, subchondral bone sclerosis, and cysts.…”

Section: Diagnosis and Therapy Of Oamentioning

confidence: 99%

Therapeutic applications of adipose-derived stromal vascular fractions in osteoarthritis

Tang¹,

Zhao²,

A³

et al. 2022

World J Stem Cells

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Osteoarthritis (OA) is considered to be a highly heterogeneous disease with progressive cartilage loss, subchondral bone remodeling, and low-grade inflammation. It is one of the world's leading causes of disability. Most conventional clinical treatments for OA are palliative drugs, which cannot fundamentally cure this disease. The stromal vascular fraction (SVF) from adipose tissues is a heterogeneous cell population. According to previous studies, it contains a large number of mesenchymal stem cells, which have been used to treat OA with good therapeutic results. This safe, simple, and effective therapy is expected to be applied and promoted in the future. In this paper, the detailed pathogenesis, diagnosis, and current clinical treatments for OA are introduced. Then, clinical studies and the therapeutic mechanism of SVF for the treatment of OA are summarized.

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ARthroscopy in Knee OsteoArthritis (ARK-OA): a multicentre study assessing compliance to national guidelines

Cited by 4 publications

References 24 publications

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Arthroscopic cartilage regeneration facilitating procedure can modify the clinical course of knee osteoarthritis

Therapeutic applications of adipose-derived stromal vascular fractions in osteoarthritis

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