A Controlled Study of Autologous Chondrocyte Implantation versus Arthroscopic Marrow Stimulation Techniques for Full‐Thickness Articular Cartilage Lesions of the Femur (SS‐23)

The Journal of Arthroscopic & Related Surgery Online osteoarthritis of the knee is largely retrospective and lacking validated health related quality of life measures.The goal of the present study was to prospectively assess and determine which patients with osteoarthritis of the knee should be offered arthroscopic debridement leading to sustained significant improvement in health related quality of life at 2 years.Methods: One hundred and twenty six patients with symptomatic primary osteoarthritis of knee underwent arthroscopic debridement of the knee after failing medical management.Two groups of surgeons (post graduate fellows and attending staff) independently evaluated the patients preoperatively using a standardized assessment of clinical symptoms, signs and plain film radiography.The intervention was arthroscopic debridement which included resection of unstable chondral flaps and meniscal tears.Abrasion was not performed.Outcome measures included WOMAC, a disease specific scale, and the SF -36, a generic outcome measure.Results: Sixty seven (53%) of the 126 patients were female and the mean age was 61.7 (± SD8.6) with a range of 43 -75.The medial compartment was more frequently and severely involved with 57% showing Grade III or IV involvement.Seventy-nine patients (62%) had an unstable meniscal tear.Fifty-six patients (44%) were rated as having had clinically significant reduction in pain at 2 years post arthroscopic debridement using the WOMAC pain scale.Physicians were poor at predicting which patients would improve: fellows' and staff accuracy were 54% and 59% respectively, and their agreement was only slightly better than chance, with a kappa of 0.27 (95% CI, 0.09, 0.45).Only 3 variables were significantly associated with improvement: the presence of medial joint line tenderness, a positive Steinman test, and the presence of unstable meniscal tear at arthroscopy.Conclusions: The prospective quality of life benefit from arthroscopic debridement of the knee is less then has been reported in previous retrospective satisfaction surveys.These results may also be useful as a baseline comparison against more sophisticated articular cartilage resurfacing procedures.Clinical variables were partially helpful for predicting success from arthroscopic debridement; a search for other biologic markers (synovial fluid) may be of benefit.