Results of arthroscopic joint debridement in different stages of chondromalacia of the knee joint

Abstract

A retrospective study was performed of 161 patients who had undergone arthroscopic operation for chondromalacia of the knee joint. After an average follow-up period of 40 (range 10-72) months, patients with severe articular cartilage lesions who had undergone articular lavage alone showed significantly poorer results (P < 0.001). With the same stage of chondromalacia and having undergone the same surgical procedure, younger patients showed better results than older patients. The more effective interruption of the circulus vitiosus during the development of degenerative joint diseases is the primary cause for better results achieved by mechanical debridement of the joint for patients suffering from grade 2 or higher. According to the literature, aggressive subchondral abrasion in severely degenerated knees does not show any benefits. Apparently, the success of the therapy depends to a great extent on the inferiority of the potential degenerative regenerate (lack of capacity of intrinsic regeneration of the hyaline cartilage) as well as on the grade and the progression of chondromalacia. Almost every second patient suffering from grade 4 chondromalacia complained of recurrent pain 1 year postoperatively. One of every 6 patients received a knee joint prosthesis within the 1st year. Therefore, the patients' preoperative expectations have to be clearly objectified. The surgical procedure as an operation with a low complication risk can also be justified as a temporary alternative to total knee arthroplasty in patients suffering from a high-grade degeneration of the joint.

Sensitivity of MRI for Articular Cartilage Lesions of the Patellae

“…Arthroscopy provides a reliable diagnosis of patellar articular cartilage lesions (9, 10). However, arthroscopical or other surgical procedures of articular cartilage lesions of the patellae is required in less than 10% of patients (9, 11), while the initial treatment comprises conservative rehabilitation (12).…”

“…Arthroscopy provides a reliable diagnosis of patellar articular cartilage lesions (9, 10). However, arthroscopical or other surgical procedures of articular cartilage lesions of the patellae is required in less than 10% of patients (9, 11), while the initial treatment comprises conservative rehabilitation (12). Arthroscopy for shaving or removing fibrillated and traumatized areas of articular cartilage is used for deeper patellae lesions grades-II to IV, despite evidence that the positive treatment outcomes may deteriorate over time (13, 14).…”

Clinical Outcomes Following Osteochondral Autologous Transplantation (OATS)

“…Lavage and debridement may offer pain relief for up to several years, but offer no prospect of long-term cure. 10,13 Similarly, marrow-stimulation techniques such as drilling, microfracture, or abra-sion arthroplasty may produce some good results, 17 but fail to provide long-term solutions because these procedures usually promote the development of fi brocartilage. Fibrocartilage lacks the durability and many of the mechanical properties of the hyaline cartilage that normally covers articular surfaces.…”

Surgical Correction of Articular Damage in the Knee: Osteoarticular Transplantation to Joint Reconstruction

“…Palliative debridement and lavage procedures are specifically targeted to older and sedentary patients with early OA for prevention of end-stage severe OA. 9 Patients with moderate and severe OA are not good candidates for this procedure 10 and should be considered for knee arthroplasty. No specific radiographic findings are related to this procedure.…”