[The use of arthroscopic debridement and viscosupplementation in knee osteoarthritis].

Abstract

We investigated the effectiveness of arthroscopic debridement followed by viscosupplementation using different hyaluronic acid (HA) products in selected patients with knee osteoarthritis. The study included 77 women (mean age 50+/-5 years; range 40 to 60 years) who had mild knee osteoarthritis according to the modified ARA (American Rheumatism Association) criteria and Ahlback classification. All the patients had degenerative meniscal tears. After three weeks from arthroscopic treatment (partial meniscectomy and debridement), the patients were randomly assigned to intra-articular injections of Na-hyaluronate (Orthovisc, n=38), streptococcal HA (Adant, n=21), and Hylan G-F 20 (Synvisc, n=18) given once a week for three weeks. Evaluations were made preoperatively, before and three weeks after injections using a patient satisfaction questionnaire, visual analog scale (VAS), and the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index. All patients had significant improvement following both arthroscopic treatment and viscosupplementation (p<0.0001). Following injections, patient satisfaction (p<0.01), WOMAC and VAS (p<0.0001) scores were significantly improved in the Na-hyaluronate and Hylan G-F 20 groups, whereas the only significant change was in VAS scores in the streptococcal HA group. However, comparison of the three groups did not yield any significant difference with respect to patient satisfaction, WOMAC, and VAS scores (p>0.05). Our results suggest that arthroscopic debridement combined with viscosupplementation is an effective treatment option for selected patients with knee osteoarthritis.