Treatment of OA of the Knee in the Middle-aged Athlete

Krych, Aaron J.; Bert, Jack M.; Levy, Bruce A.

doi:10.1097/jsa.0b013e318270d1bd

Cited by 15 publications

(25 citation statements)

References 47 publications

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“…A common treatment for these lesions is microfracture (MFX) due to the minimally invasive approach, costeffectiveness, and technical simplicity. [4][5][6] The optimal indication is a young, active patient (<40 years old) with a smaller lesion (<2 to 3 cm 2 ). 7 The resultant repair tissue is primarily fibrocartilage, which has been shown to be biomechanically inferior to hyaline articular cartilage.…”

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confidence: 99%

Clinical Outcome of Total Knee Arthroplasty After Prior Microfracture: A Matched Cohort Study

Ansari¹,

Pareek²,

Johnson³

et al. 2017

Orthopedics

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Microfracture (MFX) is a common operation for articular cartilage lesions. Data for patients who underwent total knee arthroplasty (TKA) after previous MFX are limited. The purpose of this study was to determine the outcomes, complications, and factors that influence outcomes in patients with previous MFX compared with those without previous MFX. Between 2005 and 2014, twenty-one TKAs were performed at a single tertiary care academic institution in patients with prior history of MFX surgery. These patients were retrospectively reviewed and matched 2:1 to patients who did not undergo previous MFX (n=42). Knee Society Score (KSS) (Subjective [KSS-S] and Function [KSS-F]) and complications were documented. Mean KSS-S in the MFX group increased significantly less (52.9 to 77.6) (P<.01) compared with the control group (51.3 to 83.8) (P<.01). The MFX group also demonstrated significantly less improvement in KSS-F from 63.0 to 88.9 (P=.02), whereas the control group demonstrated improvement from 52.4 to 87.1 (P=.02). At 5 years, the failure rate was 4.8% in the MFX group and 2.4% in the control group. Multivariate analysis found that older age at TKA resulted in smaller improvement in KSS-S. Paired relationships between increased age and decreased preoperative range of motion and women with an increased body mass index negatively affected KSS-S. Survivorship was similar between groups, but patients with MFX had slightly less clinical improvement compared with a matched control group. This study suggests that underlying patient factors may limit clinical improvement compared with primary TKA. [Orthopedics. 2017; 40(3):e473-e478.].

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confidence: 99%

Clinical Outcome of Total Knee Arthroplasty After Prior Microfracture: A Matched Cohort Study

Ansari¹,

Pareek²,

Johnson³

et al. 2017

Orthopedics

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“…The use of arthroscopy as a treatment for knee osteoarthritis is contentious with opposing sets of literature. 2,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Recent publications from NICE guidelines toward restricting its use and other pressures have developed to deter the surgeon from offering this treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, in Aichroth's 16,17 prospective review of 254 patients treated by arthroscopic knee debridement, 85% of the patients were satisfied with the treatment and 75% of the knees gave minimal discomfort with improved function after surgery. The average follow-up for these patients was 44 months.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the study highlights patients with mild to moderate radiographic arthritis and minimal articular cartilage involvement, and patients younger at the time of surgery showed the most improvement. 16,17 In another study by Merchan 16,18 of 38 patients, nonsurgical management was compared with arthroscopic surgery. Patients with mild osteoarthritis and normal limb alignment benefited the most from surgical intervention at short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Symptoms of Osteoarthritis in the Knee and Arthroscopy

2015

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The potential benefit of arthroscopy as a treatment for knee osteoarthritis is contentious, with National Institute for Health and Care Excellence stating that, "There is uncertainty regarding the efficacy of the procedure." This is a study of a consecutive series of patients with osteoarthritis of the knee, suffering from mechanical symptoms, such as giving way, catching, and locking, and undergoing arthroscopic debridement, including chondroplasty and meniscectomy where appropriate. A total of 33 patients were reviewed at a mean period of 24 months (standard deviation 3 months) and follow-up data were obtained for 28 of these patients. Primary outcomes measured were: number of mechanical symptom episodes per week and visual analog scores for pain. Secondary outcomes measured were: Oxford, Lysholm, and Tegner knee scores together with arc of motion of the joint. Seven patients went on to have a knee replacement within 2 years. In the patient subgroup who did not require further surgery, there was statistically significant improvement in giving way (p = 0.0184) and marginally significant improvement in catching and locking (p = 0.1105 and p = 0.087, respectively). There were statistically significant improvements found in the Oxford and Lysholm scores (p < 0.0001). An average decrease of 1.9 in the VAS pain score was observed that was also statistically significant (p < 0.0007) and an average improvement of 10 degrees in the arc of motion was noted, which was marginally significant (p = 0.0687). To our knowledge, this is the first study with a primary outcome measure of mechanical symptoms experienced by patients. The results overall suggest that patient symptoms improved following arthroscopic treatment. As a result, episodes of mechanical symptoms should be important criteria for clinicians in determining the patient suitability for arthroscopic debridement.

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“…Arthroscopic chondroplasty can theoretically help remove inflammatory mediators, mechanical cartilage fragments, and loose bodies, and some studies have shown short-term relief for a 2-year period. [10][11][12] Other studies evaluating arthroscopic treatment have demonstrated questionable results. 13,14 Advancements in cartilage restoration and arthroplasty techniques have led to improved outcomes following more invasive surgical interventions.…”

Section: Introductionmentioning

confidence: 99%