From the Guidelines
Knee arthroscopy is not recommended for patients with degenerative knee disease, including those with osteoarthritis, as it has been shown to be no better than exercise therapy in improving pain and function 1. The primary purpose of knee arthroscopy has been debated, and recent evidence suggests that it may not be as effective as previously thought for certain conditions.
- The procedure involves inserting a small camera through tiny incisions to visualize the inside of the knee joint.
- Common conditions that were previously treated with knee arthroscopy include meniscus tears, ACL injuries, cartilage damage, and removal of loose bodies. However, a randomised controlled trial published in The BMJ in 2016 found that knee arthroscopy was no better than exercise therapy for patients with a degenerative medial meniscus tear 1.
- This has led to a re-evaluation of the role of knee arthroscopy in the management of degenerative knee disease.
- Current guidelines generally discourage arthroscopy for patients with clear radiographic evidence of osteoarthritis alone 1.
- The focus has shifted towards non-operative management, including weight loss, physical therapy, exercise, and oral or topical pain medications, as the preferred initial treatment for degenerative knee disease 1.
- Knee replacement is still considered the only definitive therapy, but it is reserved for patients with severe disease after non-operative management has been unsuccessful 1.
From the Research
Purpose of Knee Arthroscopy
The purpose of knee arthroscopy is not clearly defined in the context of treating knee osteoarthritis, as studies have shown that it has no benefit in this condition 2, 3, 4.
Indications for Knee Arthroscopy
- Knee arthroscopy may be considered for patients with focal chondral defects, where bone marrow stimulation techniques such as microfracture can be used 4.
- It may also be used for diagnostic purposes or to treat conditions such as meniscal tears, although its effectiveness in these cases is still debated 3, 5.
Limitations of Knee Arthroscopy
- Arthroscopic lavage and debridement do not alter disease progression and should not be used as a routine treatment for osteoarthritic knees 4.
- The treatment effects attributed to arthroscopy are higher when prior physiotherapy is mandatory, suggesting that patient selection in studies may not represent typical indications for arthroscopy 5.
- Most randomized controlled trials on arthroscopic surgery for degenerative knee arthritis did not include documented trials of appropriate conservative treatment prior to randomization, calling into question the external validity of these studies 5.
Alternative Treatment Options
- Conservative treatment options such as physical activity, chondroitin, intra-articular injections of hyaluronic acid, and platelet-rich plasma (PRP) have been shown to be effective in reducing disability and improving quality of life in patients with knee osteoarthritis 2, 3.
- Total knee arthroplasty can be a safe, rewarding, and cost-effective treatment for patients with severe osteoarthritis 4, 6.