Is arthroscopic patella chondroplasty (surgical smoothing of the patella cartilage using an arthroscope) helpful for treating chondromalacia (cartilage softening)?

Arthroscopic Patella Chondroplasty Is Not Recommended for Chondromalacia

Arthroscopic patella chondroplasty is not recommended for treating chondromalacia as it does not provide long-term improvement in pain or function and may expose patients to unnecessary surgical risks. 1

Evidence Against Arthroscopic Intervention

The BMJ clinical practice guideline (2017) provides high to moderate quality evidence that arthroscopic knee surgery does not result in meaningful long-term improvement in pain or function for degenerative knee conditions including chondromalacia 1. Key findings include:

• Most patients experience improvement in pain and function without arthroscopy
• Less than 15% of patients show small improvements at 3 months post-surgery, but these benefits are not sustained at 1 year
• Patients are exposed to rare but important surgical risks including infection, thrombophlebitis, and anesthetic complications

Similarly, the American Academy of Orthopaedic Surgeons (AAOS) guideline strongly recommends against performing arthroscopy with debridement or lavage in patients with symptomatic osteoarthritis of the knee (Grade A recommendation with Level I and II evidence) 1.

Historical Context vs. Current Evidence

While older studies from the 1980s reported some positive outcomes with arthroscopic chondroplasty:

• A 1985 study showed 49% excellent or good results with arthroscopic chondroplasty 2
• A 1984 study suggested benefits of arthroscopic shaving and lavage 3

These studies are now outdated and have been superseded by higher quality evidence. More recent, methodologically rigorous studies have consistently shown that arthroscopic procedures provide minimal to no benefit over non-surgical approaches for degenerative knee conditions 1.

Potential Complications

Arthroscopic chondroplasty carries risks that outweigh its limited benefits:

• Surgical risks including infection, thrombophlebitis, and anesthetic complications 1
• Potential for cystic degeneration of the patella as a complication following subchondral bone perforation during chondroplasty 4

Alternative Management Approaches

For patients with chondromalacia patellae, evidence supports:

1. Conservative management as first-line treatment:

   • Physical therapy focusing on quadriceps strengthening
   • Activity modification
   • Anti-inflammatory medications

2. Consider specific exceptions only when:

   • True mechanical symptoms are present (not just pain)
   • A specific structural lesion is identified that may benefit from targeted intervention
   • Conservative management has failed after an adequate trial

Special Considerations

It's important to note that the recommendation against arthroscopic chondroplasty applies to degenerative conditions. The evidence does not address:

• Young patients with acute traumatic injuries
• Patients with true mechanical locking (not just pain)
• Cases with specific structural abnormalities like loose bodies

Conclusion

Based on the most recent high-quality evidence, arthroscopic patella chondroplasty should not be recommended for patients with chondromalacia. The procedure exposes patients to surgical risks without providing meaningful long-term benefits in pain or function compared to non-surgical approaches.