Advertisement

Debridement

  • Seth L. Sherman
  • Elliott E. Voss
  • Andrew J. Garrone
  • Clayton W. Nuelle
Chapter

Abstract

Arthroscopic debridement is a common procedure in the treatment of symptomatic chondral lesions and other concurrent intra-articular pathology. Debridement can be used in isolation to address mechanical symptoms, for unstable chondral lesions encountered during concomitant surgeries, or as part of multistage procedures, such as autologous chondrocyte implantation. Joint debridement may involve removing loose or unstable cartilaginous flaps, loose bodies, osteophytes, synovial hypertrophy, or other intra-articular debris.

Keywords

Debridement Arthroscopic Chondroplasty Radiofrequency Abrasion arthroplasty Synovectomy 

References

  1. 1.
    Falah M, Nierenberg G, Soudry M, Hayden M, Volpin G. Treatment of articular cartilage lesions of the knee. Int Orthop. 2010;34(5):621–30.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Day B. The indications for arthroscopic debridement for osteoarthritis of the knee. Orthop Clin North Am. 2005;36(4):413–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev. 2008;1:CD005118.Google Scholar
  4. 4.
    Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Edwards RB, Lu Y, Uthamanthil RK, et al. Comparison of mechanical debridement and radiofrequency energy for chondroplasty in an in vivo equine model of partial thickness cartilage injury. Osteoarthr Cartil. 2007;15(2):169–78.CrossRefPubMedGoogle Scholar
  6. 6.
    Ward BD, Lubowitz JH. Basic knee arthroscopy Part 4: chondroplasty, meniscectomy, and cruciate ligament evaluation. Arthrosc Tech. 2013;2(4):e507–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Voloshin I, Morse KR, Allred CD, Bissell SA, Maloney MD, DeHaven KE. Arthroscopic evaluation of radiofrequency chondroplasty of the knee. Am J Sports Med. 2007;35(10):1702–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Fond J, Rodin D, Ahmad S, Nirschl RP. Arthroscopic debridement for the treatment of osteoarthritis of the knee: 2- and 5-year results. Arthroscopy. 2002;18(8):829–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Uthamanthil RK, Edwards RB, Lu Y, Manley PA, Athanasiou KA, Markel MD. In vivo study on the short-term effect of radiofrequency energy on chondromalacic patellar cartilage and its correlation with calcified cartilage pathology in an equine model. J Orthop Res. 2006;24(4):716–24.CrossRefPubMedGoogle Scholar
  10. 10.
    Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43-B:752–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Mainil-Varlet P, Aigner T, Bullough P, et al. Histological assessment of cartilage repair: a report by the histology endpoint Committee of the International Cartilage Repair Society (ICRS). J Bone Joint Surg Am. 2003;85-A(Suppl 2):45–57.CrossRefGoogle Scholar
  12. 12.
    Spahn G, Klinger HM, Mückley T, Hofmann GO. Four-year results from a randomized controlled study of knee chondroplasty with concomitant medial meniscectomy: mechanical debridement versus radiofrequency chondroplasty. Arthroscopy. 2010;26(9):S73–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Edwards RB, Lu Y, Cole BJ, Muir P, Markel MD. Comparison of radiofrequency treatment and mechancial debridement of fibrillated cartilage in an equine model. Vet Comp Orthop Traumatol. 2008;21(4):41–8.PubMedGoogle Scholar
  14. 14.
    Arnoczky SP (Moderator). Is there a role for radiofrequency-based ablation in the treatment of chondral lesions? Am J Orthop. 2005;34(8 Suppl):3–15.Google Scholar
  15. 15.
    Lotto ML, Wright EJ, Appleby D, Zelicof SB, Lemos MJ, Lubowitz JH. Ex vivo comparison of mechanical versus thermal chondroplasty: assessment of tissue effect at the surgical endpoint. Arthroscopy. 2008;24(4):410–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Rocco P, Lorenzo DB, Guglielmo T, Michele P, Nicola M, Vincenzo D. Radiofrequency energy in the arthroscopic treatment of knee chondral lesions: a systematic review. Br Med Bull. 2016;117(1):149–56.CrossRefPubMedGoogle Scholar
  17. 17.
    Ganguly K, McRury ID, Goodwin PM, Morgan RE, Augé Ii WK. Histopomorphic evaluation of radiofrequency mediated débridement chondroplasty. Open Orthop J. 2010;4:211–20.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lu Y, Edwards RB, Nho S, Heiner JP, Cole BJ, Markel MD. Thermal chondroplasty with bipolar and monopolar radiofrequency energy: effect of treatment time on chondrocyte death and surface contouring. Arthroscopy. 2002;18(7):779–88.CrossRefPubMedGoogle Scholar
  19. 19.
    Edwards RB 3rd, Lu Y, Nho S, Cole BJ, Markel MD. Thermal chondroplasty of chondromalacic human cartilage. An ex vivo comparison of bipolar and monopolar radiofrequency devices. Am J Sports Med. 2002;30(1):90–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Lotto ML, Lu Y, Mitchell ME, Wright EJ, Lubowitz JH, Markel MD. An ex vivo thermal chondroplasty model: the association of a char-like layer and underlying cell death. Arthroscopy. 2006;22(11):1159–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Mead RN, Ryu J, Liu S, Ge D, Lucas J, Savoie FH 3rd, You Z. Supraphysiologic temperature enhances cytotoxic effects of bupivacaine on bovine articular chondrocytes in an in vitro study. Arthroscopy. 2012;28(3):397–404.CrossRefPubMedGoogle Scholar
  22. 22.
    Rudd RG, Visco DM, Kincaid SA, Cantwell HD. The effects of beveling the margins of articular cartilage defects in immature dogs. Vet Surg. 1987;16(5):378–83.CrossRefPubMedGoogle Scholar
  23. 23.
    Magnuson PB. Technic of debridement of the knee joint for arthritis. Surg Clin North Am. 1946;26:249–66.Google Scholar
  24. 24.
    Johnson L. Arthroscopic abrasion arthroplasty: a review. Clin Orthop Relat Res. 2001;391:306–17.CrossRefGoogle Scholar
  25. 25.
    Prejbeanu R, Poenaru DV, Balanescu AD, Mioc ML. Long term results after arthroscopic resection of medial plicae of the knee-a prospective study. Int Orthop. 2017;41(1):121–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Weckstrom M, Niva MH, Lamminen A, Mattila VM, Pihlajamaki HK. Arthroscopic resection of medial plica of the knee in young adults. Knee. 2010;17(2):103–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Lyu SR, Lee CC, Hsu CC. Medial abrasion syndrome: a neglected cause of knee pain in middle and old age. Medicine. 2015;94(16):e736. Erratum: 2015;94(21):1.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Park IH, Kim SJ, Choi DH, Lee SC, Park HY, Jung KA. Meniscectomy of horizontal tears of the lateral meniscus anterior horn using the joystick technique. Knee. 2014;21(1):315–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Anderson DE, Rose MB, Wille AJ, Wiedrick J, Crawford DC. Arthroscopic mechanical chondroplasty of the knee is beneficial for treatment of focal cartilage lesions in the absence of concurrent pathology. Orthop J Sport Med. 2017;5(5):2325967117707213.CrossRefGoogle Scholar
  30. 30.
    Owens BD, Stickles BJ, Balikian P, Busconi BD, Fu F, Eyre D. Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy. 2002;18(2):151–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Barber FA, Iwasko NG, Gilley JA, DeLee JC, Wright JC, Markel MD. Treatment of Grade III femoral chondral lesions: mechanical chondroplasty versus monopolar radiofrequency probe. Arthroscopy. 2006;22(12):1312–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Spahn G, Kahl E, Mückley T, Hofmann GO, Klinger HM. Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver: results of a prospective, randomized, controlled study. Knee Surg Sport Traumatol Arthrosc. 2008;16(6):565–73.CrossRefGoogle Scholar
  33. 33.
    Stein DT, Ricciardi CA, Viehe T. The effectiveness of the use of electrocautery with chondroplasty in treating chondromalacic lesions: a randomized prospective study. Arthroscopy. 2002;18(2):190–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Seth L. Sherman
    • 1
  • Elliott E. Voss
    • 1
  • Andrew J. Garrone
    • 1
  • Clayton W. Nuelle
    • 2
  1. 1.School of Medicine, University of MissouriColumbiaUSA
  2. 2.The Sports Institute and Burkhart Research Insitute for Orthopedics at The San Antonio Orthopedic GroupSan AntonioUSA

Personalised recommendations