Position Statement from the Australian Knee Society on ArthroscopicTue, 29 Sep 2015

Download PDF 

Position Statement from the Australian Knee Society on Arthroscopic Surgery of the Knee, with particular reference to the presence of Osteoarthritis.

In preparing the following evidence based document, the Australian Knee Society, on behalf of the Australian Orthopaedic Association, has combined the individual clinical expertise of its members with the best available external clinical evidence from a systematic review of the literature. (references listed at end of document)

Position Statement

Arthroscopic debridement, and / or lavage, has been shown to have no beneficial effect on the natural history of osteoarthritis, nor is it indicated as a primary treatment in the management of osteoarthritis. However, this does not preclude the use of arthroscopic surgery, where indicated, to manage symptomatic coexisting pathology, in the presence of osteoarthritis.

Explanatory Footnotes

Arthroscopic Surgery in the Presence of Osteoarthritis
There are certain clinical scenarios in which arthroscopic surgery, in the presence of osteoarthritis, may be appropriate - albeit after considered discussion with the patient. These include, but are not necessarily limited to, the following:

Definition of Osteoarthritis

Osteoarthritis, or degenerative joint disease, is a progressive disorder of joints characterized by gradual diffuse loss of articular cartilage, effects on the underlying bone, and secondary compromise of joint function. This should be distinguished from focal articular cartilage pathology in an otherwise normal joint, occurring more commonly in younger people. There is a spectrum of severity of osteoarthritis from minor partial thickness articular cartilage abnormalities to large areas of full thickness loss. Clinical decision making requires careful assessment of the degree of arthritis, its likely contribution to the symptoms, and the potential contribution of additional pathology to those symptoms.

Assessment and Interpretation of MRI Scanning

MRI is an excellent adjunct both to clinical decision making, and to guiding the use of surgery. In particular, it can be used to more accurately assess the degree of arthritis, and to look for and assess additional pathology that may correlate with a patient’s symptoms. MRI reports should be interpreted carefully by the treating surgeon, in combination with direct review of the imaging, when determining the clinical relevance of the findings.

Arthroscopic Surgery in the Presence of Osteoarthritis

The decision to proceed with arthroscopic surgery in the presence of osteoarthritis should be made by the treating orthopaedic surgeon:

Reference List

1. Aichroth, P. M., Patel, D. V., & Moyes, S. T. (1991). A prospective review of arthroscopic
debridement for degenerative joint disease of the knee. Int Orthop, 15(4), 351-355.
2. American Academy of Orthopaedic Surgeons. The Clinical Practice Guideline for the Treatment of
Osteoarthritis of the Knee (Non-arthroplsty)- 2nd Edition, AAOS, Rosemont; 2013. (Available at
3. Baumgaertner, M. R., Cannon, W. D., Jr., Vittori, J. M., Schmidt, E. S., & Maurer, R. C. (1990).
Arthroscopic debridement of the arthritic knee. Clin Orthop Relat Res(253), 197-202.
4. British Orthopaedic Association. Painful osteoarthritis of the knee. Commissioning guide- version
1.1, BOA, London; 2014. (Available at
5. Chang, R. W., Falconer, J., Stulberg, S. D., Arnold, W. J., Manheim, L. M., & Dyer, A. R. (1993). A
randomized, controlled trial of arthroscopic surgery versus closed-needle joint lavage for patients
with osteoarthritis of the knee. Arthritis Rheum, 36(3), 289-296.
6. Dervin, G. F., Stiell, I. G., Rody, K., & Grabowski, J. (2003). Effect of arthroscopic debridement for
osteoarthritis of the knee on health-related quality of life. JBJS(A), 85-A(1), 10-19.
7. Fond, J., Rodin, D., Ahmad, S., & Nirschl, R. P. (2002). Arthroscopic debridement for the
treatment of osteoarthritis of the knee: 2- and 5-year results. Arthroscopy, 18(8), 829-834.
8. Gauffin, A., Tagessan S., Meunier A., Magnusson H., and Kvist J. Knee Arthroscopic Surgery is
beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, singleblind
study. Osteoarthritis and Cartilage (2014) 1-9 ( Article in Press )
9. Harris, I. A., Madan, N. S., Naylor, J. M., Chong, S., Mittal, R., & Jalaludin, B. B. (2013). Trends in
knee arthroscopy and subsequent arthroplasty in an Australian population: a retrospective cohort
study. BMC musculoskeletal disorders, 14, 143.
10. Harwin, S. F. (1999). Arthroscopic debridement for osteoarthritis of the knee: predictors of patient
satisfaction. Arthroscopy, 15(2), 142-146.
11. Herrlin, S., Hallander, M., Wange, P., Weidenhielm, L., & Werner, S. (2007). Arthroscopic or
conservative treatment of degenerative medial meniscal tears: a prospective randomised trial.
Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA, 15(4), 393-401.
12. Herrlin, S. V., Wange, P. O., Lapidus, G., Hallander, M., Werner, S., & Weidenhielm, L. (2013). Is
arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A
five year follow-up. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA,
21(2), 358-364.
13. Hubbard, M. J. (1996). Articular debridement versus washout for degeneration of the medial
femoral condyle. A five-year study. J Bone Joint Surg Br, 78(2), 217-219.
14. Jackson, R. W., & Dieterichs, C. (2003). The results of arthroscopic lavage and debridement of
osteoarthritic knees based on the severity of degeneration: a 4- to 6-year symptomatic follow-up.
Arthroscopy, 19(1), 13-20.
15. Jevsevar, David S., Gregory Alexander Brown, Dina L. Jones, Elizabeth G. Matzkin, Paul A.
Manner, Pekka Mooar, John T. Schousboe et al. (2013). The American Academy of Orthopaedic
Surgeons Evidence-Based Guideline onTreatment of Osteoarthritis of the Knee. JBJS(A) 95-
A(20), no. 20 (20), 1885-1886.
16. Kalunian, K. C., Moreland, L. W., Klashman, D. J., Brion, P. H., Concoff, A. L., Myers, S., . . .
Skovron, M. L. (2000). Visually-guided irrigation in patients with early knee osteoarthritis: a
multicenter randomized, controlled trial. Osteoarthritis Cartilage, 8(6), 412-418.
17. Katz, J. N., Brophy, R. H., Chaisson, C. E., de Chaves, L., Cole, B. J., Dahm, D. L., Losina, E.
(2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. NEJM, 368(18),
18. Kirkley, A., Birmingham, T. B., Litchfield, R. B., Giffin, J. R., Willits, K. R., Wong, C. J., Fowler, P.
J. (2008). A randomized trial of arthroscopic surgery for osteoarthritis of the knee. NEJM, 359(11),
19. Laupattarakasem, W., Laopaiboon, M., Laupattarakasem, P., & Sumananont, C. (2008).
Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev(1), CD005118.
20. Livesley, P. J., Doherty, M., Needoff, M., & Moulton, A. (1991). Arthroscopic lavage of
osteoarthritic knees. J Bone Joint Surg Br, 73(6), 922-926.
21. McGinley, B. J., Cushner, F. D., & Scott, W. N. (1999). Debridement arthroscopy. 10-year
followup. Clin Orthop Relat Res(367), 190-194.
22. McLaren, A. C., Blokker, C. P., Fowler, P. J., Roth, J. N., & Rock, M. G. (1991). Arthroscopic
debridement of the knee for osteoarthrosis. Can J Surg, 34(6), 595-598.
23. Moseley, J. B., O'Malley, K., Petersen, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H.,Wray,
N. P. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. NEJM, 347(2),
24. National Institute for Health and Clinical Excellence. Arthroscopic knee washout, with or without
debridement, for the treatment of osteoarthritis. IPG 230. NICE, London; 2007
25. National Institute for Health and Clinical Excellence. Osteoarthritis: Care and management in
adults. CG177. NICE, London; 2014
26. Osteras, H., Osteras, B., & Torstensen, T. A. (2012). Medical exercise therapy, and not
arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative
meniscus injury. J Bodyw Mov Ther, 16(4), 456-463.
27. Reichenbach, S., Rutjes, A. W., Nuesch, E., Trelle, S., & Juni, P. (2010). Joint lavage for
osteoarthritis of the knee. Cochrane Database Syst Rev(5), CD007320.
28. Shannon, F. J., Devitt, A. T., Poynton, A. R., Fitzpatrick, P., & Walsh, M. G. (2001). Short-term
benefit of arthroscopic washout in degenerative arthritis of the knee. Int Orthop, 25(4), 242-245.
29. Sihvonen, R., Paavola, M., Malmivaara, A., & Jarvinen, T. L. (2013). Finnish Degenerative
Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial
on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury
with a novel 'RCT within-a-cohort' study design. BMJ Open, 3(3).
30. Sprague, N. F., 3rd. (1981). Arthroscopic debridement for degenerative knee joint disease. Clin
Orthop Relat Res(160), 118-123.
31. Timoney, J. M., Kneisl, J. S., Barrack, R. L., & Alexander, A. H. (1990). Arthroscopy update #6.
Arthroscopy in the osteoarthritic knee. Long-term follow-up. Orthop Rev, 19(4), 371-373, 376-379.
32. Vermesan, D., Prejbeanu, R., Laitin, S., Damian, G., Deleanu, B., Abbinante, A.,Cagiano, R.
(2013). Arthroscopic debridement compared to intra-articular steroids in treating degenerative
medial meniscal tears. Eur Rev Med Pharmacol Sci, 17(23), 3192-3196.
33. Yim, J. H., Seon, J. K., Song, E. K., Choi, J. I., Kim, M. C., Lee, K. B., & Seo, H. Y. (2013). A
comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears
of the medial meniscus. Am J Sports Med, 41(7), 1565-1570.

View all Resources