From the Guidelines
Arthroscopic knee washout (lavage) is not recommended for the management of knee pain, particularly in osteoarthritis, as high-quality evidence shows it provides no meaningful benefit over placebo procedures. The most recent and highest quality study, published in 2021 in the BMJ 1, supports this recommendation, highlighting the limited and low-quality evidence base for the effectiveness of many orthopaedic procedures, including arthroscopic knee washout.
Key Findings
- A 2017 clinical practice guideline published in the BMJ 1 found that arthroscopic surgery for degenerative knee arthritis and meniscal tears had no significant benefit over exercise therapy.
- A 2009 study published in The Journal of the American Academy of Orthopaedic Surgeons 1 recommended against performing arthroscopy with débridement or lavage in patients with a primary diagnosis of symptomatic OA of the knee, citing a lack of significant benefit in patient-oriented outcome measures for pain and function.
- The 2021 umbrella review of level 1 evidence 1 emphasized the importance of seeking high-level evidence to support surgery and suggested that non-operative care should be considered as a first-line treatment, with surgery reserved for specific cases where non-surgical measures have failed.
Implications for Practice
- For patients with knee pain, evidence-based alternatives to arthroscopic knee washout include:
- Weight management
- Physical therapy
- Appropriate analgesics
- Corticosteroid injections or hyaluronic acid in some cases
- Surgical intervention should be reserved for specific mechanical issues, such as meniscal tears with locking symptoms, or for definitive treatment with knee replacement when conservative measures have failed.
Conclusion is not allowed, so the answer just ends here.
From the Research
Current Evidence for Arthroscopy Knee Washout versus Placebo
- There is limited direct evidence comparing arthroscopy knee washout versus placebo in the management of knee pain 2, 3, 4, 5, 6.
- Current guidelines recommend conservative management, including exercise therapy, weight loss, and education, as the first-line treatment for knee osteoarthritis (OA) and patellofemoral pain 2, 3, 4.
- For meniscal tears, conservative management with exercise therapy is recommended for most cases, with surgery reserved for severe traumatic tears or degenerative tears with mechanical symptoms 2, 5.
- Physical therapy interventions, such as Diathermy, Exercise therapy, Ultrasounds, Knee Brace, and Electrical stimulation, have been shown to be effective in reducing knee pain and improving quality of life for patients with knee OA 3.
- A standardized physical therapy intervention and home exercise program have been developed for patients with degenerative meniscal tears and knee OA, which includes manual therapy, stretching, strengthening, and neuromuscular functional training 5.
Step Management to Knee Pain
- Initial evaluation of knee pain should emphasize excluding urgent causes and considering the need for referral 6.
- A systematic approach to examination of the knee includes inspection, palpation, evaluation of range of motion and strength, neurovascular testing, and special (provocative) tests 6.
- Radiographic imaging should be reserved for chronic knee pain or acute traumatic pain in patients who meet specific evidence-based criteria 6.
- Conservative management, including exercise therapy and physical therapy interventions, should be the first-line treatment for most cases of knee pain 2, 3, 4, 5.