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Determinants of knee replacement in subjects with a history of arthroscopy: data from the osteoarthritis initiative.

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Journal European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Year 2016
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To investigate the risk and determinants of knee replacement (KR) in subjects with or at risk of osteoarthritis (OA) and a history of arthroscopy. METHODS: Data from the osteoarthritis initiative cohort were analyzed (n = 4796, up to the seventh year of follow-up). Cox proportional hazard analysis was used to determine the risk of KR according to the history of arthroscopy. A multivariable model was used to determine the risk factors for KR among subjects with a history of arthroscopy (n = 842), including age, gender, body mass index, history of knee injury, and baseline physical activity scale for the elderly, Western Ontario and McMaster (WOMAC) total score, and radiographic Kellgren and Lawrence (KL) score. RESULTS: History of arthroscopy was associated with risk of KR after adjustments for the mentioned determinants of OA (HR: 1.90 (1.49-2.44); P value <0.001). Female gender (HR: 1.86 (1.30-2.68); P value <0.001), higher WOMAC (HR: 1.02 (1.01-1.03); P value <0.001), and KL score (HR: 2.64 (2.08-3.35); P value <0.001) increased the risk of KR among subjects with a history of arthroscopy. Subjects with a history of knee injury had 50 % lower risk of KR (HR: 0.50 (0.35-0.72); P value <0.001) after arthroscopy. CONCLUSION: Female gender, more clinical symptoms and radiographic signs of OA, was associated with higher risk of future KR in subjects with a history of arthroscopy. Subjects with arthroscopy in the setting of concomitant knee injury were 50 % less likely to undergo KR compared to subjects who underwent arthroscopy without a history of concomitant knee injury.

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Arthroscopy for Knee Osteoarthritis Has Not Decreased After a Clinical Trial.

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Journal Clinical orthopaedics and related research
Year 2016
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Multiple clinical trials have shown that arthroscopy for knee osteoarthritis is not efficacious. It is unclear how these studies have affected orthopaedic practice in the USA. QUESTIONS/PURPOSES: We questioned whether, in the Veterans Health Administration system, rates of knee arthroscopy in patients with osteoarthritis have changed after publication of the initial clinical trial by Moseley et al. in 2002, and whether rates of arthroplasty within 2 years of arthroscopy have changed during the same period. METHODS: Patients 50 years and older with knee osteoarthritis who underwent arthroscopy between 1998 and 2010 were retrospectively identified and an annual arthroscopy rate was calculated from 1998 through 2002 and from 2006 through 2010. Patients who underwent knee arthroplasty within 2 years of arthroscopy during each period were identified, and a 2-year conversion to arthroplasty rate was calculated. RESULTS: Between 1998 and 2002, the annual arthroscopy rate decreased from 4% to 3%. Of these arthroscopies, 4% were converted to arthroplasty within 2 years. Between 2006 and 2010, the annual arthroscopy rate increased from 3% to 4%. Of these arthroscopies, 5% were converted to arthroplasty within 2 years. CONCLUSIONS: Rates of arthroscopy in patients with knee osteoarthritis and conversion to arthroplasty within 2 years have not decreased with time. It may be that evidence alone is not sufficient to alter practice patterns or that arthroscopy rates for arthritis for patients in the Veterans Health Administration system were already so low that the results of the initial clinical trial had no substantial effect. LEVEL OF EVIDENCE: Level III, Retrospective cohort study.

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Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up.

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Journal BMJ (Clinical research ed.)
Year 2016
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. DESIGN: Randomised controlled superiority trial. SETTING: Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. PARTICIPANTS: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. INTERVENTIONS: 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. MAIN OUTCOME MEASURES: Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. RESULTS: No clinically relevant difference was found between the two groups in change in KOOS4 at two years (0.9 points, 95% confidence interval -4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. CONCLUSION: The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.Trial registration www.clinicaltrials.gov (NCT01002794).

Primary study

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Knee health promotion option for knee osteoarthritis: A preliminary report of a concept of multidisciplinary management

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Authors Lyu, Shaw-ruey
Journal Healthy Aging Research
Year 2015
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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Background: Osteoarthritis (OA) of the knee is a main cause of disability in the elderly population. Although there are a number of treatments that can help ease symptoms, there is, as yet, no cure. The objective of this study was to evaluate the preliminary outcome of a multidisciplinary management option based on studies of medial abrasion syndrome (MAS) as a cause of knee OA. Methods: Over a period of one year 520 patients were enrolled into this study, between them having 862 knees at different stages of OA. There were 127 males (24.4%) and 393 females (75.6%). The mean age of these patients was 65 years (SD:10). An integrated protocol for the treatment of knee OA, based on the findings of research into MAS, which we call the ``knee health promotion option (KHPO){''}, was implemented for these patients. For this preliminary report, subjective satisfaction was assessed after follow-up at one year. Results: After one year, 511 patients with 844 affected knees (97.9%) remained enrolled in the study. The mean age of these patients at the time of surgery was 64 years (SD: 10). Subjective assessment was satisfactory in 794 (94.1%) knees. Six-hundred-and-fifty-seven knees (77.8%) of 379 patients received an arthroscopic cartilage regeneration facilitating procedure (ACRFP), 71 knees (8.4%) of 70 patients received unicompartmental arthroplasty (UKA), and 116 knees (13.8%) of 116 patients received total knee arthroplasty (TKA). For the arthroplasty group, the subjective assessment was satisfactory in 187 knees (100%). For the ACRFP group, the subjective assessment was satisfactory in 607 knees (92.4%). In the ACRFP group, the satisfactory rate was 91.2% for 228 stage II knees, 93.6% for 327 stage III knees, and 91.2% for 102 stage IV knees. Three knees in the stage IV group had converted to arthroplasy after the minimum follow-up of one year. Conclusions: According to this preliminary report, KHPO targeting on the MAS as a cause of knee OA could provide patients with a high degree of treatment satisfaction. Further studies are mandatory to investigate their long-term outcomes.

Primary study

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Effect of exercise therapy compared with arthroscopic surgery on knee muscle strength and functional performance in middle-aged patients with degenerative meniscus tears: a 3-mo follow-up of a randomized controlled trial.

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Authors Stensrud S , Risberg MA , Roos EM
Journal American journal of physical medicine & rehabilitation
Year 2015
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: The aim of this study was to compare the effect of a 12-wk exercise therapy program and arthroscopic partial meniscectomy on knee strength and functional performance in middle-aged patients with degenerative meniscus tears. DESIGN: A total of 82 patients (mean age, 49 yrs; 35% women) with a symptomatic, unilateral, magnetic resonance imaging-verified degenerative meniscus tear and no or mild radiographic osteoarthritis were randomly assigned to a supervised neuromuscular and strength exercise program or arthroscopic partial meniscectomy. Outcomes assessed 3 mos after intervention initiation were isokinetic knee muscle strength, lower extremity performance, and self-reported global rating of change. RESULTS: Mean difference in isokinetic knee extension peak torque between the two groups was 16% (95% confidence interval, 7.1-24.0) (P < 0.0001), favoring the exercise group. Patients in the exercise group improved isokinetic knee extension peak by a mean of 25 Nm (range, 18-33 Nm) from baseline to follow-up. Furthermore, patients assigned to exercise therapy showed statistically significant improvements (P ≤ 0.002) in all other measured variables, with moderate to large effect sizes (0.5-1.3). Patients reported a similar and positive effect of both interventions. CONCLUSION: A 12-wk supervised exercise therapy program yielded clinically relevant and statistically significant improvement in isokinetic quadriceps strength immediately after completion of the program, as compared with treatment with arthroscopic partial meniscectomy.

Primary study

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Long-term results of abrasion arthroplasty for full-thickness cartilage lesions of the medial femoral condyle.

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Journal Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Year 2015
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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PURPOSE: To evaluate the long-term functional results of arthroscopic abrasion arthroplasty for the treatment of full-thickness cartilage lesions of the medial femoral condyle. METHODS: Between 1990 and 1996, 75 consecutive patients with isolated chondral lesions of the medial femoral condyle were treated with arthroscopic chondral abrasion. A retrospective analysis of the clinical results of this cohort was performed. The patients were evaluated according to the Knee Society Score questionnaire preoperatively, at 10 years postoperatively, and at final long-term follow-up at a mean of 20 years. At final follow-up, they were also assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index. Patients were divided according to the lesion size and by age, and the Kaplan-Meier survivorship function (with second operation taken as an endpoint) for the various groups was calculated. RESULTS: At a mean of final follow-up of 20 years (range, 16.94 to 23.94 years), a positive functional outcome (Knee Society Score ≥70 points or no reoperation) was recorded in 67.9% of the patients. Twenty-year survivorship in this cohort was 71.4% (95% confidence interval, 0.5690 to 0.8590). The survivorship was 89.5% for patients younger than 50 years and 55.7% for patients aged 50 years or older. The functional results for patients with lesions smaller than 4 cm(2) were significantly better than those for patients with lesions of 4 cm(2) or greater (P = .031). There were no statistical differences between patients with and without associated lesions at the time of surgery. CONCLUSIONS: Our hypothesis that there would be survivorship greater than 86% was disproved. However, arthroscopic abrasion arthroplasty can be a valid treatment for medial femoral condylar full-thickness defects of the knee, even in the long-term, particularly for younger patients and those with smaller lesions. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Primary study

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Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study

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Journal Osteoarthritis and cartilage
Year 2014
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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Objective: There is no evidence that a knee arthroscopy is more beneficial to middle-aged patients with meniscal symptoms compared to other treatments. This randomised controlled trial aimed to determine whether an arthroscopic intervention combined with a structured exercise programme would provide more benefit than a structured exercise programme alone for middle-aged patients with meniscal symptoms that have undergone physiotherapy. Method: 150 out of 179 eligible patients, aged 45 to 64 (mean:54 ± 5), symptom duration more than 3 months and standing X-ray with Ahlbäck grade 0, were randomised to: (1) a physiotherapy appointment within 2 weeks of inclusion that included instructions for a 3-month exercise programme (non-surgery group); or (2) the same as (1) plus, within 4 weeks of inclusion, knee arthroscopy for resection of any significant meniscal injuries (surgery group). The primary outcome was change in pain at 12 months, assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOSPAIN). Results: In the Intention-To-Treat analysis, pain at 12 months was significantly lower in the surgery than in the non-surgery group. The change in KOOSPAIN was significantly larger in the surgery than in the non-surgery group (between-group difference was 10.6 points of change; 95% CI: 3.4 to 17.7, P = 0.004). The As-Treated analysis results were consistent with the Intention-To-Treat analysis results. Conclusion: Middle-aged patients with meniscal symptoms may benefit from arthroscopic surgery in addition to a structured exercise programme. Patients' age or symptom history (i.e., mechanical symptoms or acute onset of symptoms) didn't affect the outcome. Trial registration: NCT01288768. © 2014 Osteoarthritis Research Society International.

Primary study

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The relationship between knee arthroscopy and arthroplasty in patients under 65 years of age.

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Journal The Journal of arthroplasty
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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A private payer database was used to examine the incidence and rates of knee arthroscopy in patients less than 65 years of age and the subsequent risk of knee arthroplasty. Time to event analysis was performed using the Kaplan-Meier method; also, Cox regression analysis was used to evaluate the relative risk of subsequent knee arthroplasty for arthroscopic patients. Overall, 247,034 knee arthroscopies, done for injury or arthropathy, were identified between 2004 and 2009. Within 1-year of arthroscopy, 2.2% of arthropathy patients and 0.9% of injury patients underwent a knee arthroplasty. These increased to 5.2% and 2.4% at 5-years, respectively. The risk of arthroplasty following arthroscopy increased significantly with age. Further study is warranted to examine the benefit of arthroscopy in younger patients with OA.

Primary study

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Single coronary artery anomaly without previous myocardial infarction does not cause ischemic mitral insufficiency.

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Authors Saeed G , Gradaus R , Neuzner J
Journal Asian cardiovascular & thoracic annals
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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Dilemma of high rate of conversion from knee arthroscopy to total knee arthroplasty.

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Journal American journal of orthopedics (Belle Mead, N.J.)
Year 2014
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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We tried to reduce our rate of conversion from index knee arthroscopy to total knee arthroplasty (TKA) for degenerative pathology (primarily meniscal) in the setting of coexisting arthritis in patients 50 years or older. We hypothesized that, by using a 2-surgeon independent evaluation method, we could reduce the rate to less than 10% by 3-year follow-up. Forty-two consecutive patients were initially evaluated by the knee replacement surgeon to determine if they were TKA candidates. They were then independently evaluated by another surgeon regarding the need for TKA and the possibility of arthroscopic debridement. The data showed a tendency: The under-10% target rate was nearly reached in patients younger than 65 years (12%; 2/17) but not in patients older than 65 years (36%; 9/25). The overall rate of conversion to TKA was 26%. The 2 main groups (arthroscopy only, arthroscopy-plus-TKA) did not differ in all measured characteristics. Failure of our method to achieve better outcomes demonstrates that conventional criteria are poor in predicting which patients with meniscal pathology, which is believed to be relatively more symptomatic than coexisting arthritis, should avoid arthroscopy and go straight to TKA.