Dearing Jonathan, Nutton Richard W
Department of Orthopaedic Surgery, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom.
Knee. 2008 Jun;15(3):159-63. doi: 10.1016/j.knee.2008.02.004. Epub 2008 Apr 2.
Arthroscopy continues to be widely used in the management of knee osteoarthritis despite concerns regarding its effectiveness. The Scottish Arthroplasty Project has demonstrated a three-fold variation in rates of arthroscopy for osteoarthritis of the knee across different regions of Scotland. This has clear ramifications for the utilisation of finite health care resources. In light of such variations in national clinical practice this review identifies the evidence based factors which permit identification of patients who will obtain sustained benefit from arthroscopic treatment of knee osteoarthritis. Such a patient should have symptoms of short duration affecting the medial compartment of the knee, have localised tenderness at the medial joint line, mechanical symptoms and positive findings on meniscal stress testing. There should be neither significant mechanical malalignment nor flexion contracture, there should be preservation of the joint space on radiographs and the patient should not be obese. If these criteria are fulfilled the likelihood for long lasting reduction in symptoms is increased.
尽管对关节镜治疗膝关节骨关节炎的有效性存在担忧，但关节镜检查仍在膝关节骨关节炎的治疗中广泛应用。苏格兰关节置换项目表明，苏格兰不同地区膝关节骨关节炎的关节镜检查率存在三倍的差异。这对有限医疗资源的利用有着明显的影响。鉴于全国临床实践中的此类差异，本综述确定了基于证据的因素，这些因素有助于识别能从膝关节骨关节炎关节镜治疗中获得持续益处的患者。这样的患者应具有影响膝关节内侧间室的短期症状，在内侧关节线处有局限性压痛、机械性症状以及半月板应力试验阳性结果。不应存在明显的机械性对线不良或屈曲挛缩，X线片上应保留关节间隙，且患者不应肥胖。如果满足这些标准，症状长期减轻的可能性会增加。
