arthroscopic lavage and debridement for ... - Semantic Scholar

ARTHROSCOPIC

LAVAGE

AND

OSTEOARTHRITIS

J. N. ALASTAIR

GIBSON,

MICHAEL

We measured objective quadriceps

either

relieved

studies alone

torque

have

ment of the joint surfaces al 1984) can relieve some the

pain,

of

early

afterjoint

arthroscopic

or combined

of

the

knee.

of the joint or to increase muscle strength. the quadriceps acting across an osteoarthritic weakened (Gibson et al 1989), we measured contractile treatment.

properties

PATIENTS We

selected

arthritis closed

20 patients

of the envelope,

debridement

before

AND with

removal

and

after

symptoms Association

were scale

(Aichroth

moderate

unilateral

of osteophytes.

using

the

There

knee by comparing

was some

improvement

but not after debridement.

The

Neither

MDW

muscle and

(Cybex,

Lumex,

powers

VMC)

pre-operatively We used a Cybex

(Davies 1987). The reported elsewhere subject was seated using pelvic, shoulder

arthro-

axis was performed

and tested

Massachusetts)

of the warm-up

knee. Each repetitions

flexion at each test velocity. first and the following test peak

contraction

flexion. Three maximal made over five seconds

of

each effort. The largest force one second was measured. 2) Concentric quadriceps contractions through 90#{176} of velocities of 60#{176} and 180#{176} per

at

30#{176} and

©

1992 British 030l-620X/92/4386

J Bone Joint

534

to Mr

Table

I. Details

of 20 patients

Age (yr) (mean Orthopaedic

of

J. N. A. Gibson.

Editorial Society of Bone $2.00 Surg [Br] 1992 ; 74-B :534-7.

and

Joint

The normal sequence was 90#{176} of knee

voluntary contractions with rest for ten seconds maintained

subject of knee

were between

for a period

and hamstring isokinetic knee flexion were made second.

of

at

Orthopaedic

V. M. Chapman, MCSP, Senior Physiotherapist M. D. White, MCSP, Senior Physiotherapist Department of Physiotherapy, Royal Infirmary Lauriston Place, Edinburgh EH3 9YW, Scotland. be sent

the by legs

reliability of the machine has been (Johnson and Siegel 1978). The with the back and trunk stabilised and thigh straps. The dynamometer

by or

over 70 or valgus

also

physio-

and six and 12 II isokinetic dyn-

treated

by lavage

or debridement

Lavage

should

were

in the

Cambridge,

aligned to that five sub-maximal

used: 1) Isometric

osteo-

et al 1978).

J. N. A. Gibson, MD, FRCS Ed(Orth), Lecturer R. K. Strachan, FRCS, Senior Lecturer Clinical Research Unit, Princess Margaret Rose Fairmilehead, Edinburgh EH1O 7ED, Scotland.

Correspondence

in

method

interfaced to an IBM personal computer to measure isometric and concentric isokinetic torques generated the quadriceps and hamstring muscles in both

radiograph, each patient’s

British

hamstring

(by

department, after operation.

amometer

Since joint is quad-

details

and

blindly

therapy weeks

et

METHODS

on a weight-bearing days before operation,

scored

K. STRACHAN

of the osteoarthritic operation.

lavage

extension leg was

the two groups are shown in Table I. Patients years of age or with more than 20#{176} varus deformity, measured were excluded. Two

after

assessed

Precise

knee and allocated them randomly, to treatment by arthroscopic lavage

with

and

Quadriceps

debride-

indications for surgical intervention and evidence as to which procedures should be undertaken, however, are not always clearly defined (Dandy 1991) and neither treatment has been shown to improve the movement

riceps scopic

ROBIN

of Edinburgh

lavage,

with

(Magnuson 1941 ; Friedman of the symptoms, particularly

osteoarthritis

KNEE

M. CHAPMAN,

and debridement

before

FOR

symptoms.

that

1991)

lavage

function

at six and 12 weeks

the patients’

suggested

(Jackson

muscle

THE

VALERIE

the University

of arthroscopic

of thigh

isokinetic

significantly Several

the effect

measurements

OF

D. WHITE,

From

DEBRIDEMENT

Surgery

Hospital,

Edinburgh,

Weight

1

±

(range)

SD)

(kg)(mean

± sD)

Debridement

53 ± 10 (38 to 68)

57 ± 7 (45 to 69)

80 ± 13

76 ± 13

Side(R:L)

5:5

4:6

Sex(M:F)

6:4

8:2

± sD)

107 ± 20

100 ± 14

± SD)

10 ± 9

Flexion Symptom Previous

range

(degrees)

duration

(mean

(yr)(mean

meniscectomy

8± 7

2

THE

JOURNAL

OF BONE

3

AND

JOINT

SURGERY

ARTHROSCOPIC

At arthroscopy ofosteoarthritis from Outerbridge

under

general

AND

anaesthesia

DEBRIDEMENT

arthroscopes

holder were applied dependent position

as appropriate.

and using

Chondral

Loebl A

the knee 30#{176} and

defects

were

classified by multiplying the scores for area and for depth. The severity of osteophyte formation was estimated by measuring the the sum

the lengths

size of a probe, and knee. The ‘aggregate

and then

widths

of osteophytes

mapping area’ score

them was

against

on a chart of based on the

of the products oflength and width. Patients in the group treated by debridement

osteophytes articular notchplasty England).

removed to produce margins. Arthroscopic were used (Baxter Neither chondroplasty

had

a normal contour of the blades designed for Health Care, Croydon, (scarification to bleed-

smoothed off. No patient in either group had a displaced meniscal tear. In both groups, each of the medial, lateral and patellofemoral joint compartments were washed out irrigation fluid and weighed.

Table II. Scoring system the knee at arthroscopy

for osteoarthritis

lesion

I 2 3 4

Softening Fibrillation Partial-thickness Full-thickness

removed

Osteophytes (aggregate

1 Small : < 1 cm2 2 Moderate : < 2 cm2 cm2 3 Large:>2

areas)

tissues

I Minor synovitis 2 Degenerate meniscus or tear 3 Medial and lateral degenerate meniscus or tear

Laboratories, Slough, England) before rapid quenching in melting isopentane (cooled in liquid nitrogen). Cryotome sections (10 .tm) were stained by Mg-ATPase to

74-B,

No.

the two main fibre types (Mabuchi and and the mean least diameter of 100 fibres of determined by an automatic computer-

4, JULY

biopsy

from

groups

after

gave

receiving

ethics

2A,

Elliptical

and

the measurements. U test was used and written

paired

consent and

Joyce-

distorted

for comparison

Student’s

a verbal

of the purposes and risks the studies was granted research

(Magiscan

England).

observations. Each patient

to

a written

of the procedure. by the Lothian

t-test

for

quadriceps explanation

Approval for Health Board

committee.

RESULTS The severity of joint degeneration score) was similar in the two groups the score for osteophyte ment group. The mean

size was weight

irrigation was 2.4 g ± 1 .9 after with 0.9 g ± 0.8 after lavage (p The not SD)

clinical

improve before

after surgery

scores

for

either and

(total (Table

arthroscopic III), although

greater in the debrideof debris removed by
2cm2

differentiate Sr#{233}ter1980) each type

independent

535

KNEE

system

Gateshead,

were excluded The Mann-Whitney

of

Area ofchondral lesions

Soft

of

THE

image-analysis Ltd,

fibres

OF

Score

Criterion Chondral depth

was

OSTEOARTHRITIS

all

ing subchondral bone) nor saucerisation of chondral defects was used (Pridie 1959; MacIntosh and Welsh 1977). Loose articular cartilage was excised and any degenerate margins of the medial or lateral menisci were

with one litre of saline. The by powered suction, filtered

FOR

integrated

the degree

was scored as shown in Table II (modified 1961 ; Keene and Dyreby 1983).

tourniquet and thigh was examined in the 700

LAVAGE

Total S

An

p