Arthroscopic Management of Moderate-to-Severe Osteoarthritis of the Knee: A Systematic Review.

BACKGROUND

Total knee arthroplasty (TKA) is the procedure of choice for osteoarthritis of the knee (OAK) when conservative treatment fails; however, high rates of dissatisfaction and poor implant longevity dissuade younger patients from TKA. There is a paucity of evidence that report outcomes and clinical effectiveness of arthroscopic knee procedures in patients with end-stage (grade 3-4) OAK. The purpose of this systematic review was to evaluate the efficacy of arthroscopic treatment for patients with moderate-to-severe (grade 3-4) OAK.

METHODS

A systematic review of the literature was performed with the terms "Knee," "Osteoarthritis," and/or "Arthroscopic debridement," "Arthroscopic lavage," "Arthroscopic microfracture," "Arthroscopic chondroplasty," "debridement," "lavage," "chondroplasty," "microfracture," and/or "arthroscopy" in PubMed (MEDLINE), Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases in November 2023 according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases were searched for studies that evaluated outcomes (e.g., pain, function, and conversion to TKA) for patients with Kellgren-Lawrence grade 3 to 4 OAK after knee arthroscopy (including debridement, lavage, microfracture, or chondroplasty) at a minimum 6-month follow-up. Percent improvement from preoperative score was the primary outcome measure. Secondary outcome measures included achievement of minimal clinically importance difference and conversion to TKA.

RESULTS

Nine studies (410 knees with grades 3-4 OAK) were included. Arthroscopic debridement and lavage resulted in a 18.8% to 53.1% improvement at short-term follow-up (e.g., 6 months to 3 years) and a 50.0% improvement at long-term follow-up (e.g., 10 years) in knees with grade 3 OAK and a 15.0% to 41.3% improvement at short-term follow-up and a 46.9% improvement at long-term follow-up in knees with grade 4 OAK. Arthroscopic debridement and microfracture resulted in 1.6% to 50.8% improvement at short-term follow-up in knees with grade 3 OAK. No studies included long-term outcomes or evaluated knees with grade 4 OAK after arthroscopic debridement and microfracture. Conversion to TKA after arthroscopic debridement and lavage occurred in 21.9% of patients with grade 3 OAK and in 35.0% of patients with grade 4 OAK at short-term follow-up and in 47.4% of patients with grade 3 OAK and in 76.5% of patients with grade 4 OAK at long-term follow-up. Conversion to TKA after arthroscopic debridement and microfracture occurred in 10.9% of patients with grade 3 and 4 OAK at long-term follow-up.

CONCLUSION

Arthroscopic debridement, lavage, and microfracture can provide short- and long-term symptomatic relief and improvement in function by up to 50.0% in patients with grade 3 to 4 OAK. These procedures may result in fewer patients with grade 3 OAK undergoing TKA compared with patients with grade 4 OAK.

LEVEL OF EVIDENCE

Level IV; systematic review of Level II-IV studies. See Instructions for Authors for a complete description of levels of evidence.