Knee arthroscopy in the older patient

Abstract

With seniors living longer, more active, healthier lives, arthroscopy in the senior knee has become a commonlyperformed orthopaedic procedure., Because of the favorable risk-benefit ratio of arthroscopy when compared with more invasive procedures such as arthroplasty or osteotomy, the procedure is often offered as a temporizing measure to patients in whom it may be of only short-term benefit. Appropriate patient selection is imperative to a successful outcome. Based on currently available data, the following patient variables can be associated with favorable postoperative outcomes: normal roentgenographic limb alignment, history of mechanical symptoms, minimal or no roentgenographic signs of degeneration, short duration of symptoms, and no previous surgery. With minimal associated morbidity, it appears that arthroscopic lavage may be considered as a palliative treatment option for osteoarthritic knees; however, results deteriorate over time. Preexisting degenerative articular changes, not age, have often been reported as the most important predicting factor for the outcome following arthroscopic partial meniscectomy in the elderly. Although the results of arthroscopic partial meniscectomy are poorer in patients with significant degenerative joint disease, the results appear to be acceptable in the short term. In active seniors with mild degenerative knee arthritis, conservative arthroscopic debridement is the initial procedure of choice after a nonoperative regimen has failed. Because of its unpredictability, high failure rate, and prolonged rehabilitation phase, abrasion arthroplasty has fallen out of favor as a primary treatment for degenerative arthritis of the knee in the older, active patient.