DEBRIDEMENT, ABRASION and MICROFRACTURE for OSTEOARTHRITIS of the KNEE
These interventions might be expected to decrease the mechanical stress on cartilage, thus lessening cartilage loss, and to prevent the release of yet more fragments, thereby interrupting a vicious circle of joint damage and synovitis.
LAVAGE
|
It removes debris such as free microscopic or macroscopic fragments of cartilage,
calcium phosphate crystals, and others chemical products that may induce synovitis,
a likely source of pain.
|
Removal of loose body. |
DÉBRIDEMENT
|
It consists in smoothing rough, fibrillated articular and removal of torn menisci, shaving
tibial-spine osteophytes and loose body removal that interfere with the motion of the joint,
and minor synovectomy removing inflamed synovium. |
debridment of cartilage flap |
ARTHROSCOPIC ABRASION ARTHROPLASTY
Back to top
Popularised by Lanny L. JOHHNSON in the 1980’s , it is a superficial abrasion performed to
stimulate repair in the area of sclerotic lesions. Open surgical drilling procedures
(PRIDIE) have been advocated to reach the blood supply and the plupotential cells to stimulate
fibrocartilage growth. Rather than drill holes , mulitple superficial dimples are created with a
motorized burr. This abrasion of sclerotic bone leads to bleeding and formation of a blood clot
that attaches to anf fills the defect of abraded areas and will transform in fibrocartilage by 4 to 6 months.
Patient have to walk with non weight bearing crutches during two months and malalignement
is a contraindication (limiting patient selection).
abrasion with burr |
repair tissue at 5 months |
THE MICROFRACTURE
|
Described by Rodrigo in 1994 includes removal of the calcified cartilage layer of exposed subchondral bone and the perforation of the subchondral plate with specially designed arthroscopic awls to restore a hyaline-like cartilage surface ; The same as in the abrasion arthroplasty, this technique provides access to biologic modulators of healing and to mesenchymal stem cells that have the ability to differentiate into cartilagelike-cells and produce a durable repair cartilage. This cellular differentiation ultimately leads to the development and proliferation of a durable repair cartilage that fills the original defect. |
|
It requires limited weight bearing in conjunction with continuous passive motion.
Full passive ROM of the injured knee is gained as soon as possible after surgery.
As well as crutch-assisted touchdown weight bearing for 6–8 weeks.
The technique is better suited to isolated full-thickness articular cartilage lesions than for
generalized arthritis in the knee.
The recovery is long because of the physiologic remodeling of the regenerate.
The arthroscopically debridement and microfracture procedure are recommended as the initial treatment
for traumatic full-thickness chondral defects of the knee rather than fot arthritis.
OUR OPINION
Arthroscopic debridement techniquesof the arthritic knee remain a source of controversy in the surgical
management of osteoarthritic knees. In the litterature, clinical success in the arthritic knee has
varied between 50% and 65%. The best short-term results are observed with good fill grade,
low body-mass index, and a short duration of preoperative symptoms.
Despite their current popularity, lavage and débridement are probably not efficacious as
treatments for most persons with osteoarthritis of the knee. For the subgroup of knees with loose
bodies or flaps of meniscus or cartilage that are causing mechanical symptoms, especially locking,
catching, or giving way of the joint, there is a consensus that arthroscopic removal of these unstable
tissues improves joint function and alleviates symptoms. II may prolonge the time to surgery.
A conservative arthroscopic debridement technique appears to have a more limited role today than in the past.
Hyaluronic acid injectable agents (viscosupplementation) have become increasingly popular and may be other
solution to debridements.
Last updated : 9/12/2007
