Systematic review finds no advantage in using arthroscopic debridement for treating knee OA

The most reliable study reviewed found that, compared to sham surgery, arthroscopic debridement produced worse outcomes at 2 weeks and no significant difference at 2 years.

Performing arthroscopic debridement does not appear to provide patients with greater relief of the pain and swelling caused by knee osteoarthritis compared to either lavage or placebo surgery, according to a meta-analysis published in the Cochrane Database of Systematic Reviews.

However, "Debatable areas remain to be addressed; for example, there may be groups of patients or levels of severity of disease for which the intervention may be effective," the study authors wrote. "Hubbard 1996 found that [arthroscopic debridement] provides more successful results for localized lesions on the medial femoral condyle than arthroscopic washout, but the study was of lower methodological quality."

"Surgeons should make a careful decision about using [arthroscopic debridement] for the treatment of knee osteoarthritis (OA)," lead author Wiroon Laupattarakasem, MD, of Khon Kaen University in Thailand, said in a press release announcing the study. "It should by no means be regarded as inappropriate for every knee."

Laupattarakasem and colleagues searched the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE and Web of Science to identify either randomized, controlled trials or controlled clinical trials evaluating the effectiveness of arthroscopic debridement compared to another surgical procedure and other nonsurgical interventions.

The systematic review focused on patients diagnosed with either primary or secondary knee OA "who did not have other joint involvement or conditions requiring long-term use of [NSAIDs]," according to the study.

From the search, which also included bibliographies, reference lists and cited Web sites of papers, the researchers identified three studies involving 271 total patients. These three studies had different comparison groups and a moderate risk of bias, the authors reported.

The largest and most reliable study compared arthroscopic debridement with both lavage and sham surgery and found no significant difference between arthroscopic debridement and lavage. In addition, the study found that, compared to sham surgery, arthroscopic debridement produced worse outcomes at 2 weeks postop and no significant difference at 2 years.

Only about half of the eligible patients agreed to participate in this study, the reviewers noted, and such self-selection reduces the relevance of the study to the general population. Those who participated were more likely to expect benefits from the treatment, which might have contributed to the positive results among the placebo group, according to the press release.

The second study included in the review, which had a higher risk of bias, compared arthroscopic debridement and arthroscopic washout. Researchers found that debridement significantly reduced knee pain compared to washout at 5 years follow-up.

The third study, which also had a higher risk of bias, compared arthroscopic debridement to closed-needle lavage. Similar to the first study, this third trial also found no significant difference between the two procedures, the authors reported.

According to the review, the latter two studies produced low-quality evidence because there were fewer than 50 patients in each treatment group. The studies also employed less-reliable research methods.

Clinicians must make decisions regarding arthroscopic debridement on a case-by-case basis.

"There may be certain types of pathology or certain levels of disease severity for which arthroscopic debridement can be more effective," Laupattarakasem said in the release. "Future research on this topic should analyze larger numbers of participants with various types of soft-tissue damage and levels of arthritis severity."

Since performing sham surgery is subject to ethical questions, the reviewers recommend that future projects compare various treatment options to one another.

Future studies should also clearly describe specific surgical techniques, as arthroscopic debridement can include a variety of procedures. The inclusion of bone abrasion and microfracture techniques could produce different results.

They also recommend that future studies not only report pain and mobility, which can be subjective, but report a more objective measure: when patients require further treatment to sustain joint function.

For more information:
Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis (Review). Cochrane Database Syst Rev. 2008; Issue 1. Art. No.: CD005118. DOI: 10.1002/14651858.CD005118.pub2.