An arthroscopic treatment regimen for osteoarthritis of the knee.
OBJECTIVE
The purpose of this study was to evaluate the functional and subjective outcomes of patients with moderate to severe osteoarthritis of the knee who underwent a comprehensive arthroscopic treatment regimen.


METHODS
Between August 2000 and November 2001, 69 knees in 61 patients were treated with an arthroscopic regimen. Inclusion criteria included severe osteoarthritis and a minimum 2-year follow-up. Arthroscopic treatment included joint insufflation, lysis of adhesions, anterior interval release, contouring of cartilage defects to a stable rim, shaping of meniscus tears to a stable rim, synovectomy, removal of loose bodies, and removal of osteophytes that affected terminal extension. Exclusion criteria included the treatment of chondral defects with microfracture. Failure was defined as knees requiring arthroplasty because this was what patients were trying to avoid.


RESULTS
The average patient age was 57 (range, 37-78), with 35 men and 26 women. Patients had an average of 1.5 previous surgeries (range, 0-12). The average preoperative Lysholm score was 49 (range, 14-79). On average, knees were insufflated with 170 mL of lactated Ringer's solution (range, 120-240). Nine knees failed, with survivorship of 83% at 3 years. At an average follow-up of 31 months (range, 24-41), the average Lysholm score was 74 (range, 37-100), with an average improvement of 25 points. The average Tegner score was 4 (range, 0-8). Average patient satisfaction was 8 (range, 1-10). The average Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain score was 4 (range, 0-14), WOMAC stiffness was 2 (range, 0-4), and WOMAC function was 11 (range, 0-44). Independent predictors of improvement in Lysholm score included a shift in the weight-bearing axis and preoperative Lysholm score.


CONCLUSIONS
This arthroscopic treatment regimen can improve function and activity levels in patients with moderate to severe osteoarthritis. Of 69 patients, 60 (87%) patients had a satisfactory result. However, in this group of 60, 11 patients needed a second procedure, resulting in a 71% satisfactory result after 1 surgery.


METHODS
Level IV, therapeutic case series.
Steadman
J Richard
JR
Steadman Hawkins Research Foundation, Vail, Colorado 81657, USA.
Ramappa
Arun J
AJ
Maxwell
R Brian
RB
Briggs
Karen K
KK
D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function