Arthroscope-guided surgery versus nonoperative treatment for limited degenerative osteoarthritis of the femorotibial joint in patients over 50 years of age: A prospective comparative study

Merchan, E. C. Rodríguez; Galindo, E.

doi:10.1016/s0749-8063(05)80503-1

Cited by 84 publications

(45 citation statements)

References 21 publications

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“…31 Jackson and Dieterichs 33 found that lavage and debridement provide significant relief in patients with osteoarthritis if the intervention is performed during the acute stage of degeneration. Two separate prospective trials of debridement in individuals with limited degenerative osteoarthritis of the femorotibial joint 42 and lavage in individuals with non-end-stage knee osteoarthritis 32 displayed significant improvements in knee pain when compared to nonoperatively treated groups.…”

Section: Palliative Technique: Arthroscopic Lavage and Debridementmentioning

confidence: 99%

The Basic Science and Surgical Treatment Options for Articular Cartilage Injuries of the Knee

Tetteh¹,

Bajaj²,

Ghodadra³

2012

Journal of Orthopaedic & Sports Physical Therapy

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Synopsis The complex structure of articular cartilage allows for diverse knee function throughout range of motion and weight bearing. However, disruption to the structural integrity of the articular surface can cause significant morbidity. Due to an inherently poor regenerative capacity, articular cartilage defects present a treatment challenge for physicians and therapists. For many patients, a trial of nonsurgical treatment options is paramount prior to surgical intervention. In instances of failed conservative treatment, patients can undergo an array of palliative, restorative, or reparative surgical procedures to treat these lesions. Palliative methods include debridement and lavage, while restorative techniques include marrow stimulation. For larger lesions involving subchondral bone, reparative procedures such as osteochondral grafting or autologous chondrocyte implantation are considered. Clinical success not only depends on the surgical techniques but also requires strict adherence to rehabilitation guidelines. The purpose of this article is to review the basic science of articular cartilage and to provide an overview of the procedures currently performed at our institution for patients presenting with symptomatic cartilage lesions. J Orthop Sports Phys Ther 2012;42(3):243–253. doi:10.2519/jospt.2012.3673

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Section: Palliative Technique: Arthroscopic Lavage and Debridementmentioning

confidence: 99%

The Basic Science and Surgical Treatment Options for Articular Cartilage Injuries of the Knee

Tetteh¹,

Bajaj²,

Ghodadra³

2012

Journal of Orthopaedic & Sports Physical Therapy

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“…45 Harwin 27 found through retrospective review that lavage and debridement were of most value in patients with specific localized mechanical symptoms, minimal malalignment, and no history of previous surgery. Additionally, in separate prospective trials, both, debridement 40 and lavage 30 resulted in significant improvements in knee pain when compared to nonoperatively treated cohorts. This procedure represents a reasonable first-line palliative treatment for individuals with low physical demands, but likely does not offer a long-term solution.…”

Section: Arthroscopic Lavage and Debridementmentioning

confidence: 96%

Basic Science and Treatment Options for Articular Cartilage Injuries

Lewis

McCarty²,

Kang³

et al. 2006

J Orthop Sports Phys Ther

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Articular cartilage injuries can produce significant musculoskeletal morbidity for both young and active aging patient populations. The complex and highly specialized composition of normal hyaline cartilage makes treatment of focal chondral injuries a formidable challenge for the basic scientist, surgeon, and physical therapist. The current array of surgical treatment options offers palliative, reparative, and restorative treatment strategies. Palliative options include simple arthroscopic debridement. Reparative strategies utilize marrow stimulation techniques to induce formation of fibrocartilage within the chondral defect. Restorative tactics attempt to replace damaged cartilage with hyaline or hyaline-like tissue using osteochondral or chondrocyte transplantation. Furthermore, while treatment success is obviously dependent on good surgical selection and technique, the importance of sound, compliant postoperative rehabilitation cannot be understated. The purpose of this article is to review the basic science of articular cartilage, current treatment options available, and outline the clinical decision making involved when using these procedures by presenting the algorithm used at our institution for treating focal cartilage lesions.

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“…Before 2002, several small randomized trials of debridement (Merchan et al 1993) and lavage (Ike et al 1992) found that these therapies reduced knee pain. Knee arthroscopy was a well-accepted, Hollingsworth et al (2010a) to distinguish between owners and non-owners.…”

Section: Assumptionmentioning

confidence: 99%

Selective Hearing: Physician-Ownership and Physicians' Response to New Evidence

Howard

David

Hockenberry

2016

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Physicians, acting in their role as experts, are often faced with situations where they must trade off personal and patient welfare. Physicians' incentives vary based on the organizational environment in which they practice. We use the publication of a major clinical trial, which found that a common knee operation does not improve outcomes for patients with osteoarthritis, as an "informational shock" to gauge the impact of physicians' agency relationships on treatment decisions. Using a 100% sample of procedures in Florida from 1998 to 2010, we find that publication of the trial reduced procedure volume, but the magnitude of the decline was smaller in physician-owned surgery centers. Incentives affected physicians' reactions to evidence.

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Arthroscope-guided surgery versus nonoperative treatment for limited degenerative osteoarthritis of the femorotibial joint in patients over 50 years of age: A prospective comparative study

Cited by 84 publications

References 21 publications

The Basic Science and Surgical Treatment Options for Articular Cartilage Injuries of the Knee

The Basic Science and Surgical Treatment Options for Articular Cartilage Injuries of the Knee

Basic Science and Treatment Options for Articular Cartilage Injuries

Selective Hearing: Physician-Ownership and Physicians' Response to New Evidence

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