Factors Affecting The Outcome Of Arthroscopy In Early Osteoarthritis Of The Knee

Objective: Arthroscopy has been carried out in the treatment of osteoarthritis of the knee, but because of the lack of efficacy is still controversial. As its advantage of "minimally invasive", it has not been completely deny so far. Practice and literature show that arthroscopy for treatment of early osteoarthritis of the knee is advanced more satisfied. In this paper, some representative factors were retrospectively analyzed, study the relevant factors affecting the efficacy of arthroscopic treatment of knee osteoarthritis.Methods: 252 cases underwent arthroscopic treatment of knee osteoarthritis from January 2003 to February 2005 in our hospital were admitted to our retrospective analysis. All the patients had knee pain symptom and seriously affect daily life after expectant treatment like analgesic and conservative. The screening criterian was developed avccording to the duration of symptoms of pain, limb alignment, Kellgren-Lawrence classification and preoperative magnetic resonance(MR) of subchondral bone edema. Age, gender, duration of symptoms and interlocking symptoms were obtained from the medical history. Pain piont and body mass index(BMI) were acquired by preoperative physical examination. Meniscus lesion, K-L classification and loose body were obtained from preoperative radiology,and cases with subcartilage edema and limb alignment changed was excluded simultaneously. Knee arthralgia was evaluated by the visual analogue scoring system(VAS),and knee function was evaluated by Lysholm scoring system. Outerbridge cartilage classification and involved compartment were record from results of arthroscopic,while meniscus lesion and loose body were identified once again. Micro-fracture functional exercise program will be implemented after surgery, and patients should be evaluated again with visual analogue scoring system and Lysholm scoring system a fter a year. Operation was considered effective when the preoperative and postoperative Lysholm score difference was a positive number, otherwise regarded as invalid. The relationship between factors and outcomes were analyzed by Chi-square test or t-test, measurement data and outcome by linear correlation and non-conditional Logistic regression was used for screening independent factors.Results: 159 cases were valid, 93 cases in valid, accounted for 63.1% and 36.9% of the total. Except for gender(c2=1.826,P=0.177)and involved compartment(c2=0.099, P=1.752), significant difference could be spotted in age(c2=47.244,P=0.000), tenderness(c2=41.731, P=0.000), K-L classification(c2=35.483, P=0.000), meniscus lesion(c2=103.5, P=0.000), loose body(c2=11.664,P=0.001), joint interlocking(c2=17.153, P=0.000), symptom duration time(c2=11.395, P=0.003), Outerbridge cartilage classification(c2=52.663,P=0.000), BMI(c2=5.722,P=0.016) and preoperative VAS score(c2=12.387, P=0.007) from chi-square test.Groups were established on the basis that contained gender, age, tenderness, K-L classification, meniscus lesion, loose body, joint interlocking, symptom duration time, involved compartment, Outerbridge cartilage classification and BMI. Linear statistical inference was based on the d value as the dependent variable and age, BMI, preoperative VAS score and VAS core differential as independent variables. Results suggest that linear correlation was inexistence in outcome with both of the three factors except for VAS core differential. According to the results of multi-factor analysis, age(OR=0.338,P=0.026), K-L classification(OR=4.537,P=0.000), meniscus lesion( OR=5.773,P=0.000), joint interlocking( OR=2.527,P=0.024), tenderness( OR=4.830,P=0.000), BMI( OR=2.394,P=0.034) and Outerbridge cartilage classification(OR=3.292,P=0.006) were risk factors of curative effect.Conclusion: Arthroscopic treatment of early knee osteoarthritis is associated with some representative factors.These factors include the results of physical examination, radiology and arthroscopic findings. satisfactory curative effect was fonud in patients with meniscus lesion, loose body and pain piont,except for the age more than 60 years.It also can be achieved from cases with K-L grade I and Outerbridgeand grade I- II. assessing above factors deedy, controlling surgical indications strictly and selecting appropriate cases to be trial of debridement combined with micro- fracture can improve the overall satisfactory rate of arthroscopic in erely knee osteoarthritis.