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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.
Lavage is common to all other techniques.

Removal of loose body
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.
The procedure became increasingly popular in the 1980s and1990s with improved arthroscopic instrumentation and surgical technique as well as the minimal morbidity and swift recovery after the procedure.

debridment of cartilage flap
debridment of cartilage flap

ARTHROSCOPIC ABRASION ARTHROPLASTY

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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
abrasion with burr
repair tissue at 5 months
repair tissue at 5 months

THE MICROFRACTURE

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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.

Microfracture

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

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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

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