Osteoarthritis in the knee is the degradation or deterioration of articular cartilage, responsible for pain mainly on walking and radiological impingement on loading.
Knee operation by arthroscopy
The therapeutic arsenal available to the traumatologist once the medical treatment (anti-inflammatory, analgesics, chondroprotectors, etc.), physiotherapy or infiltrations in the joint (corticosteroids, hyaluronic acid or platelet-rich plasma) does not help is surgical treatment, of which arthroscopic surgery stands out. Within the arthroscopic section, the main techniques are:
- Meniscectomy: consists of removing a small broken fragment or, if possible, suturing it.
- Chondrectomy: consists of removing unstable cartilage fragments and leaving their surface flat.
- Osteophytomy: it consists of removing the “parrot’s beaks”.
- Extraction of free bodies
- Mosaicplasty: aims to fill cartilage defects with the patient’s own bone, donor bone or other substances that stimulate cartilage formation.
- Synovectomy: consists of removing pathological synovial tissue, which causes inflammation and pain.
- Perforations: this involves making several micro-orifices in the damaged cartilage in order to stimulate blood supply to the area.
- Abrasion: aims to flatten damaged areas of articular cartilage.
- Microfractures: aims to cause small fractures in the cartilage seeking an effect similar to that of perforations.
- External wing section: external support of the patella and that in some cases causes the displacement of the same one and causes that it rubs in a painful way.
Diagnosis and treatment of the knee osteoarthritis
It is clear that there is no uniformity of criteria for the diagnosis and treatment of each patient with osteoarthritis of the knee, so it would be necessary to create a study group that could lay the foundations and proposals for the future treatment of this very common pathology.
For the moment, there are two important issues on which agreement has been reached in relation to its practice:
- Meniscectomy in degenerative knee: it should be partial, palliative, cleaning, and only of an unstable tongue, being its best prognosis the traumatic meniscal injury (acute).
- Arthroscopy prior to osteotomy: it is known that tibial osteotomy has good results without associated arthroscopy, that arthroscopy lengthens somewhat the surgical time and that it may have the risk of contraindicating an osteotomy in favor of a prosthesis.
Even so, arthroscopy also has a very important role in the diagnosis of knee osteoarthritis, since, according to an investigation, 40% of patients with chondropathies III and IV had normal radiographs.
Thus, in patients under 65-70 years of age with knee pain of several months of evolution and in whom radiological tests do not show damage in accordance with the symptoms present, arthroscopy can be an important diagnostic aid (in certain cases also therapeutic), being also of great help in assessing the prognosis to be expected within the evolution of the osteoarthritic process.
Therefore, in all these lesions generated by osteoarthritis of the knee, arthroscopic surgery has a very important role. Not only does it serve to have an important knowledge of what is the real situation inside that joint and to see what lesions have developed, but it also serves to immediately repair some of these lesions and above all to make a future prognosis and planning for their treatment in the more or less distant future.