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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2012

Open Access 01-12-2012 | Technical advance

Arthroscopic cartilage regeneration facilitating procedure for osteoarthritic knee

Authors: Shaw-Ruey Lyu, Chia-Chen Hsu, Chih-Wen Lin

Published in: BMC Musculoskeletal Disorders | Issue 1/2012

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Abstract

Background

The effectiveness of arthroscopic treatment for osteoarthritic knee is a controversy. This study presents the technique of a novel concept of arthroscopic procedure and investigates its clinical outcome.

Method

An arthroscopic procedure targeted on elimination of focal abrasion phenomenon and regaining soft tissue balance around patello-femoral joint was applied to treat osteoarthritis knees. Five hundred and seventy-one knees of 367 patients with osteoarthritis received this procedure. There were 70 (19%) male and 297 (81%) female and the mean age was 60 years (SD 10). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. The roentgenographic changes of femoral-tibial angle and joint space width were evaluated for objective outcomes. The mean follow-up period was 38 months (SD 3).

Results

There were 505 knees in 326 patients available with more than 3 years follow-up and the mean follow-up period was 38 months (SD 3). The subjective satisfactory rate for the whole series was 85.5%. For 134 knees with comprehensive follow-up evaluation, the KSS and all subscales of the KOOS improved statistically. The femoral-tibial angle improved from 1.57 degrees (SD 3.92) to 1.93 degrees (SD 4.12) (mean difference: 0.35, SD 0.17). The joint space width increased from 2.02 millimeters (SD 1.24) to 2.17 millimeters (SD 1.17) (mean difference: 0.13, SD 0.05). The degeneration process of the medial compartment was found being reversed in 82.1% of these knees by radiographic evaluation.

Conclusions

Based on these observations arthroscopic cartilage regeneration facilitating procedure is an effective treatment for osteoarthritis of the knee joint and can be expected to satisfy the majority of patients and reverse the degenerative process of their knees.
Appendix
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Literature
1.
Bitton R: The economic burden of osteoarthritis. Am J Manag Care. 2009, 15: S230-S235.PubMed
2.
Brandt KD, Mazzuca SA: Lessons learned from nine clinical trials of disease-modifying osteoarthritis drugs. Arthritis Rheum. 2005, 52: 3349-3359. 10.1002/art.21409.CrossRefPubMed
3.
Chang RW, Falconer J, Stulberg SD, Arnold WJ, Manheim LM, Dyer AR: A randomized, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients with osteoarthritis of the knee. Arthritis Rheum. 1993, 36: 289-296. 10.1002/art.1780360302.CrossRefPubMed
4.
Al-Omran AS, Sadat-Ali M: Arthroscopic joint lavage in osteoarthritis of the knee. Is it effective?. Saudi Med J. 2009, 30: 809-812.PubMed
5.
Jackson RW, Dieterichs C: The results of arthroscopic lavage and debridement of osteoarthritic knees based on the severity of degeneration: a 4- to 6-year symptomatic follow-up. Arthroscopy. 2003, 19: 13-20.CrossRefPubMed
6.
Kuzmanova SI: Treatment of knee osteoarthritis by arthroscopic synovectomy and debridement of cartilage lesions–late results. Folia Med (Plovdiv). 2003, 45: 66-72.
7.
Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C: Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev. 2008, 1: CD005118-PubMed
8.
Bert JM: Role of abrasion arthroplasty and debridement in the management of osteoarthritis of the knee. Rheum Dis Clin North Am. 1993, 19: 725-739.PubMed
9.
Singh S, Lee CC, Tay BK: Results of arthroscopic abrasion arthroplasty in osteoarthritis of the knee joint. Singapore Med J. 1991, 32: 34-37.PubMed
10.
Johnson LL: Arthroscopic abrasion arthroplasty historical and pathologic perspective: present status. Arthroscopy. 1986, 2: 54-69. 10.1016/S0749-8063(86)80012-3.CrossRefPubMed
11.
Friedman MJ, Berasi CC, Fox JM, Del Pizzo W, Snyder SJ, Ferkel RD: Preliminary results with abrasion arthroplasty in the osteoarthritic knee. Clin Orthop Relat Res. 1984, 182: 200-205.PubMed
12.
Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR: Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009, 37: 2053-2063. 10.1177/0363546508328414.CrossRefPubMed
13.
Asik M, Ciftci F, Sen C, Erdil M, Atalar A: The microfracture technique for the treatment of full-thickness articular cartilage lesions of the knee: midterm results. Arthroscopy. 2008, 24: 1214-1220. 10.1016/j.arthro.2008.06.015.CrossRefPubMed
14.
Miller BS, Steadman JR, Briggs KK, Rodrigo JJ, Rodkey WG: Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg. 2004, 17: 13-17.PubMed
15.
Siparsky P, Ryzewicz M, Peterson B, Bartz R: Arthroscopic treatment of osteoarthritis of the knee: are there any evidence-based indications?. Clin Orthop Relat Res. 2007, 455: 107-112.CrossRefPubMed
16.
Lyu SR: Arthroscopic medial release for medial compartment osteoarthritis of the knee: the result of a single surgeon series with a minimum follow-up of four years. J Bone Joint Surg Br. 2008, 90: 1186-1192.CrossRefPubMed
17.
Kellgren JH LJ: Atlas of standard radiographs: the epidemiology of chronic rheumatism. Vol. 2. 1963, Oxford: Blackwell
18.
Marx RG, Connor J, Lyman S, Amendola A, Andrish JT, Kaeding C: Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med. 2005, 33: 1654-1657. 10.1177/0363546505275129.CrossRefPubMed
19.
Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M: Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum. 2007, 56: 1204-1211. 10.1002/art.22515.CrossRefPubMed
20.
Mazzuca SA, Brandt KD, Buckwalter KA, Lequesne M: Pitfalls in the accurate measurement of joint space narrowing in semiflexed, anteroposterior radiographic imaging of the knee. Arthritis Rheum. 2004, 50: 2508-2515. 10.1002/art.20363.CrossRefPubMed
21.
Vignon E, Piperno M, Le Graverand MP, Mazzuca SA, Brandt KD, Mathieu P: Measurement of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon schuss views. Arthritis Rheum. 2003, 48: 378-384. 10.1002/art.10773.CrossRefPubMed
22.
Grelsamer RP, Bazos AN, Proctor CS: Radiographic analysis of patellar tilt. J Bone Joint Surg Br. 1993, 75: 822-824.PubMed
23.
Kraus VB, Vail TP, Worrell T, McDaniel G: A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis Rheum. 2005, 52: 1730-1735. 10.1002/art.21100.CrossRefPubMed
24.
Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH: A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002, 347: 81-88. 10.1056/NEJMoa013259.CrossRefPubMed
25.
Richmond J, Hunter D, Irrgang J, Jones MH, Snyder-Mackler L, Van Durme D: American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am. 2010, 92: 990-993. 10.2106/JBJS.I.00982.CrossRefPubMed
26.
27.
Hunt SA, Jazrawi LM, Sherman OH: Arthroscopic management of osteoarthritis of the knee. J Am Acad Orthop Surg. 2002, 10: 356-363.CrossRefPubMed
28.
Bae DK, Yoon KH, Song SJ: Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy. 2006, 22: 367-374. 10.1016/j.arthro.2006.01.015.CrossRefPubMed
29.
Rosenberger RE, Gomoll AH, Bryant T, Minas T: Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older. Am J Sports Med. 2008, 36: 2336-2344. 10.1177/0363546508322888.CrossRefPubMed
30.
Lyu SR, Hsu CC: Medial plicae and degeneration of the medial femoral condyle. Arthroscopy. 2006, 22: 17-26. 10.1016/j.arthro.2005.08.039.CrossRefPubMed
31.
Lyu SR, Tzeng JE, Kuo CY, Jian AR, Liu DS: Mechanical strength of mediopatellar plica--the influence of its fiber content. Clin Biomech (Bristol, Avon). 2006, 21: 860-863. 10.1016/j.clinbiomech.2006.03.010.CrossRef
32.
Lyu SR: Relationship of medial plica and medial femoral condyle during flexion. Clin Biomech (Bristol, Avon). 2007, 22: 1013-1016. 10.1016/j.clinbiomech.2007.08.001.CrossRef
33.
Lyu SR, Chiang JK, Tseng CE: Medial plica in patients with knee osteoarthritis: a histomorphological study. Knee Surg Sports Traumatol Arthrosc. 2010, 18: 769-776. 10.1007/s00167-009-0946-2.CrossRefPubMed
34.
Wang HS, Kuo PY, Yang CC, Lyu SR: Matrix metalloprotease-3 expression in the medial plica and pannus-like tissue in knees from patients with medial compartment osteoarthritis. Histopathology. 2011, 58: 593-600. 10.1111/j.1365-2559.2011.03783.x.CrossRefPubMed
35.
Ikeuchi M, Takahashi T, Tani T: Localized synovial hypertrophy in the anteromedial compartment of the osteoarthritic knee. Arthroscopy. 2005, 21: 1457-1461. 10.1016/j.arthro.2005.09.011.CrossRefPubMed
36.
Paulos LE, O'Connor DL, Karistinos A: Partial lateral patellar facetectomy for treatment of arthritis due to lateral patellar compression syndrome. Arthroscopy. 2008, 24: 547-553. 10.1016/j.arthro.2007.12.004.CrossRefPubMed
37.
Calpur OU, Ozcan M, Gurbuz H, Turan FN: Full arthroscopic lateral retinacular release with hook knife and quadriceps pressure-pull test: long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2005, 13: 222-230. 10.1007/s00167-003-0474-4.CrossRefPubMed
38.
Larson RL, Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T: The patellar compression syndrome: surgical treatment by lateral retinacular release. Clin Orthop Relat Res. 1978, 134: 158-167.PubMed
39.
Fu FH, Maday MG: Arthroscopic lateral release and the lateral patellar compression syndrome. Orthop Clin North Am. 1992, 23: 601-612.PubMed
40.
Bigos SJ, McBride GG: The isolated lateral retinacular release in the treatment of patellofemoral disorders. Clin Orthop Relat Res. 1984, 186: 75-80.PubMed
41.
Becerra J, Andrades JA, Guerado E, Zamora-Navas P, Lopez-Puertas JM, Reddi AH: Articular cartilage: structure and regeneration. Tissue Eng Part B Rev. 2010, 16: 617-627.CrossRefPubMed
42.
Hwang NS, Elisseeff J: Application of stem cells for articular cartilage regeneration. J Knee Surg. 2009, 22: 60-71. 10.1055/s-0030-1247728.CrossRefPubMed
43.
Elder BD, Athanasiou KA: Hydrostatic pressure in articular cartilage tissue engineering: from chondrocytes to tissue regeneration. Tissue Eng Part B Rev. 2009, 15: 43-53. 10.1089/ten.teb.2008.0435.CrossRefPubMedPubMedCentral
44.
Pereira RC, Scaranari M, Castagnola P, Grandizio M, Azevedo HS, Reis RL: Novel injectable gel (system) as a vehicle for human articular chondrocytes in cartilage tissue regeneration. J Tissue Eng Regen Med. 2009, 3: 97-106. 10.1002/term.145.CrossRefPubMed
45.
Zhang L, Hu J, Athanasiou KA: The role of tissue engineering in articular cartilage repair and regeneration. Crit Rev Biomed Eng. 2009, 37: 1-57. 10.1615/CritRevBiomedEng.v37.i1-2.10.CrossRefPubMedPubMedCentral
46.
Solchaga LA, Goldberg VM, Caplan AI: Cartilage regeneration using principles of tissue engineering. Clin Orthop Relat Res. 2001, S161-S170. 391 Suppl
47.
48.
Onyekwelu I, Goldring MB, Hidaka C: Chondrogenesis, joint formation, and articular cartilage regeneration. J Cell Biochem. 2009, 107: 383-392. 10.1002/jcb.22149.CrossRefPubMed
49.
Odenbring S, Egund N, Lindstrand A, Lohmander LS, Willen H: Cartilage regeneration after proximal tibial osteotomy for medial gonarthrosis. An arthroscopic, roentgenographic, and histologic study. Clin Orthop Relat Res. 1992, 277: 210-216.PubMed
50.
Kanamiya T, Naito M, Hara M, Yoshimura I: The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy. 2002, 18: 725-729. 10.1053/jars.2002.35258.CrossRefPubMed
51.
Koshino T, Wada S, Ara Y, Saito T: Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee. 2003, 10: 229-236. 10.1016/S0968-0160(03)00005-X.CrossRefPubMed
52.
Aigner T, Soeder S, Haag J: IL-1beta and BMPs--interactive players of cartilage matrix degradation and regeneration. Eur Cell Mater. 2006, 12: 49-56. discussion 56.PubMed
53.
Sandell LJ, Aigner T: Articular cartilage and changes in arthritis. An introduction: cell biology of osteoarthritis. Arthritis Res. 2001, 3: 107-113. 10.1186/ar148.CrossRefPubMedPubMedCentral
54.
Thorstensson CA, Andersson ML, Jonsson H, Saxne T, Petersson IF: Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria. Ann Rheum Dis. 2009, 68: 1890-1893. 10.1136/ard.2008.095158.CrossRefPubMed
55.
Wolfe F, Lane NE: The longterm outcome of osteoarthritis: rates and predictors of joint space narrowing in symptomatic patients with knee osteoarthritis. J Rheumatol. 2002, 29: 139-146.PubMed
56.
Spector TD, Hart DJ, Doyle DV: Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Ann Rheum Dis. 1994, 53: 565-568. 10.1136/ard.53.9.565.CrossRefPubMedPubMedCentral
57.
Hernborg JS, Nilsson BE: The natural course of untreated osteoarthritis of the knee. Clin Orthop Relat Res. 1977, 130-137.
58.
Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman BN, Aliabadi P: The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1995, 38: 1500-1505. 10.1002/art.1780381017.CrossRefPubMed
59.
Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D: Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000, 43: 995-1000. 10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1.CrossRefPubMed
Metadata
Title
Arthroscopic cartilage regeneration facilitating procedure for osteoarthritic knee
Authors
Shaw-Ruey Lyu
Chia-Chen Hsu
Chih-Wen Lin
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2012
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-13-226

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