Minimally invasive arthroscopy for moderate to severe knee osteoarthritis and its indications

Objective To discuss the clinical indications and effects of minimally invasive arthroscopy for 40-plus-year-old patients with moderate to severe knee osteoarthritis(KOA).Methods A retrospective study was conducted to include a total of 64 patients(21 males and 43 females)with moderate to severe KOA who had been operated on from August 1995 to August 2002.Their average age was 52.6 ± 8.2years old.Their positive and negative physical signs before and after surgery and articular cartilage injuries as well were recorded.The knee society clinical rating system(KSS)scores before operation and at the last follow-up were recorded for every patient.Indications for KOA arthroscopy were based on a comprehensive analysis of age,previous therapies,Ⅹ-ray changes,knee function,and possible clinical effects of arthroscopy for the patient.Results They were followed up for an average of 5.3 ± 1.3 years.Of the 64 cases,52needed total or partial meniscectomy,20 removal of loose bodies,and 2 anterior cruciate ligament reconstruction.The cartilage injury occurred mostly and the most seriously in the trochlea,next in the patella and then in the medial compartments.The positive physical signs decreased from 363 times before arthroscopy to 214 at the last follow up(x2 =60.121,P=0.000).The knee score,function score and total KSS score improved very significantly(P < 0.05).The excellent to good rate was 84.4%.Of the 10 poor cases,8 accepted total knee arthroplasty within one year after arthroscopy.Conclusions Satisfactory clinical results can be achieved for moderate and severe KOA by minimally invasive arthroscopy if its indications are well followed and techniques are properly used during operation.But excessive use of arthroscopy for KOA should be avoided because unreasonable arthroscopy may cause a severe KOA patient to sustain total knee arthroplasty soon. Key words: Knee joint; Osteoarthritis; Arthroscopy