title: Mechanical Symptoms of Osteoarthritis in the Knee and Arthroscopy.
abstract: 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.
authors.affiliation: Acorn Ward, Hull Royal Infirmary, Hull, United Kingdom.
authors.forename: Metin Tolga
authors.initials: MT
authors.lastname: Buldu
authors.affiliation: Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, West Midlands, United Kingdom.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Marsh
authors.affiliation: Department of Trauma and Orthopaedics, Heart of England NHS Foundation Trust, Birmingham, West Midlands, United Kingdom.
authors.forename: Jamie
authors.initials: J
authors.lastname: Arbuthnot
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001182:Arthroscopy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000601:surgery*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome