Kirkley et al.124 reported that a large number of patients were not eligible for participation in their study (38%) largely due to the exclusion criteria of substantial knee malalignment. In some cases, patients declined participation. Kirkely et al.124 compared arthroscopic surgery to lavage and debridement combined with usual physical therapy and medical treatment, usual care. The authors used the pain, functional status and other symptoms subscales of the Arthritis Self-Efficacy Scale (ASES) and the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR) at multiple time points (ranging from three months to two years). Out of 20 outcomes, only two were statistically significant in favor of surgery with lavage. Differences in AIMS pain were statistically significant at three months and differences in AIMS-Other Arthritis Symptoms subscale scores remained significant after two years. In summary, this randomized controlled trial demonstrated no benefit of arthroscopic surgery compared to physical therapy and medical treatment for osteoarthritis of the knee.
Kalunian et al.125 included a large number of enrolled patients from one institution with intraarticular crystals in their knee. They compared arthroscopic lavage with 3,000 ml saline to lavage with 250 ml saline. There were not any statistically significant differences in VAS and WOMAC pain scores between the two treatment groups.
The Moseley et al.126 study raised questions regarding its limited sampling (mostly male veterans) as well as the number of potential study participants who declined randomization into a treatment group. In this RCT, the effects of arthroscopy with debridement or lavage were not statistically significant in the vast majority of patient oriented outcome measures for pain and function, at multiple time points from one week to two years following surgery.
Collectively all three included studies did not demonstrate clinical benefit of arthroscopic debridement or lavage. The work group also considered the potential risks to patients (anesthesia intolerance, infection, and venous thrombosis) associated with surgical intervention.
It was agreed that the lacking evidence for treatment benefit and increased risks from surgery were sufficient reasons to recommend against arthroscopic debridement and/or lavage in patients with a primary diagnosis of osteoarthritis of the knee.
None of the evidence we examined specifically included patients who had a primary diagnosis of meniscal tear, loose body, or other mechanical derangement, with concomitant diagnosis of osteoarthritis of the knee. The present recommendation does not apply to such patients.
- (124) Kirkley A, Birmingham TB, Litchfield RB et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008;359(11):1097-1107. PM:18784099
- (125) Kalunian KC, Moreland LW, Klashman DJ et al. Visually-guided irrigation in patients with early knee osteoarthritis: a multicenter randomized, controlled trial. Osteoarthritis Cartilage 2000;8(6):412-418. PM:11069725
- (126) Moseley JB, O'Malley K, Petersen NJ et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002;347(2):81-88. PM:12110735