A REVIEW OF 2021 AND 2022 AAOS GUIDELINES FOR MENISCAL ARTHROSCOPIC PROCEDURES IN OSTEOARTHRITIS

Abstract

For many decades, arthroscopy was considered the least invasive of all existing surgical methods of treating patients with gonarthrosis, however, carried out at the beginning of the XXI century randomized clinical trials (RCTs) demonstrated the futility of isolated lavage and debridement for this category of patients. The purpose of this work is to show trends in the indications for debridement and partial meniscectomy in patients with osteoarthritis in the 2021–2022 AAOS guidelines. Methods. AAOS 2021, 2022 recommendations for the treatment of osteoarthritis (without arthroplasty). The strength of recommendations depends on the number and quality of studies that may or may not recommend surgery. The results. In 2021, the third edition of the AAOS clinical guidelines for the treatment of osteoarthritis was released, which was supported by four studies. They suggest that arthroscopic partial meniscectomy be used for the treatment of meniscal tears in patients with concomitant mild or moderate osteoarthritis in whom physical therapy or other nonsurgical treatments have been ineffective. The 2022 AAOS guidelines reviewed 216 osteoarthritis situations and indications for arthroscopic procedures. The developed criteria are aimed at covering the most common clinical scenarios faced by qualified specialists treating osteoarthritis of the knee joint. The final decision on any particular criterion must take into account all the circumstances presented by the patient, as well as the needs and resources specific to the area or institution. Conclusions. The 2021 AAOS guidelines do not recommend arthroscopy with lavage and/or debridement in patients with a primary diagnosisof knee osteoarthritis. According to AAOS 2022 recommendations, arthroscopic interventions are suitable for young people with arthrosis of the knee joint in one or 2–3 departments. Arthroscopy as a method of choice for the treatment of terminal gonarthrosis has exhausted itself: most studies prove the ineffectiveness of lavage, debridement, microfracturing of the subchondral bone, and partial meniscectory.