Arthroscopic Debridement of Mild and Moderate Knee Osteoarthritis Results in Clinical Improvement at Short-Term Follow-Up: A Systematic Review

Abstract

To report the clinical outcomes of arthroscopic debridement for the treatment of Kellgren Lawrence (KL) grades I and II (mild), and III (moderate) knee osteoarthritis (OA) at minimum 1-year follow-up. A systematic review of primary literature was performed in concordance with PRISMA guidelines using the Medline, Embase, and Cochrane databases for studies regarding arthroscopic debridement/chondroplasty for management of knee OA at minimum 1-year follow-up. Studies were included if they included KL grades I-III or dichotomized clinical outcomes by KL grade. The primary outcome was patient-reported outcome measures (PROMs) at the final follow-up. Bias was assessed using the methodological index for non-randomized studies (MINORS) score. Eight studies including a total of 773 patients met inclusion criteria (range of patients in each study 31-214). Mean age of patients ranged from 35.5 - 64 years with most studies having a mean patient age of 55-65 years. Mean follow-up ranged 1.5-10 years. Seven of the 8 (87.5%) studies reported good to excellent PROMs at a minimum of 14 year follow-up after arthroscopic debridement. Improvements in PROMs were superior in patients with less severe knee OA (KL I-II) in comparison to KL III in most studies. Conversion to arthroplasty ranged from 7.6%-50% in KL III patients compared to 0%-4.5% in KL I-II after arthroscopic debridement.Two of the 3 studies with at least 4-year clinical follow-up reported that clinical improvements diminished with time (improvements no longer significant in total Western Ontario and McMaster Universities Osteoarthritis Index score). The lone randomized controlled trial was the only investigation that did not find a benefit of arthroscopic debridement over quality nonoperative care. MINORS scores ranged from 6-10 (mean 8.0) for the 5 non-randomized studies without controls. Arthroscopic debridement for management of mild to moderate knee osteoarthritis is effective at short-term follow up in patients who have exhausted conservative care.. There is limited evidence demonstrating the durability of improvement following arthroscopic debridement after 2 years. Level IV: Systematic review of level I-IV studies.