Scoping Knees

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Scoping Knees

• Jennifer Watson
• Surgical Care Practitioner
• Sheffield Teaching Hospitals
• 23/02/05

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• Diagnostic Arthroscopies
• Used to confirm osteoarthritis
• Lavage and Debridement
• Washing the knee joint with copious amounts of
  fluid
• Removing any loose, scaling or desquaminating
  cartilage fragments

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Introduction

• Recommendations for training
• Clinical standards or best practise guidelines
• Rationale and evidence for procedure

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Training

• General Medical Council
• British Orthopaedic Association
• National Association for Assistants in Surgical
  Practice
• Sheffield Knee Arthroscopy Training School
• Anatomy
• Effects of Manipulation
• Knee Pathologies
• Hand/eye co-ordination
• Tool handling skills

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Best Practice Guidelines

• British Association for Surgery of the Knee
• Arthroscopic ACL repair

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History

• Bircher 1921, Burman 1934
• WW II
• 1970s - interest revived
• Refinement and upgrading of equipment
• Movement from eyepiece to monitor

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Jackson et al

• Series of articles from 1970 to present
• Major role in early detection of pathology
• Arthroscopic surgery not a cure
• Up to 80 showed reduction of symptoms
• Improvement only in very early stages of
  osteoarthritis

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Moseley, 2002

• First randomised, double-blind placebo-controlled
  trial
• Debridement, Lavage, Placebo
• 2 year follow-up
• Pain, function, walking assessment
• No difference in improvement between groups

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Wai et al, 2002

• Audited future treatment of patients undergoing
  arthroscopy between 1992 and 1996
• Administrative data only used
• Challenged idea that arthroscopies significantly
  postponed arthroplasty
• Suggested that arthroscopies overused in elderly

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Dervin et al, 2003

• Looked at effect of arthroscopic debridement on
  health-related quality of life
• Patients joint space and anatomical axis assessed
  pre-op using standing x-rays
• Fewer patients than in previous studies reported
  benefits
• Symptom relief related to mechanical problems

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Iorio and Healy, 2003

• Discussed treatment options for osteoarthritis
  including
• Medication
• Weight Loss
• Exercise and Physiotherapy
• Aids
• Arthroscopic Surgery
• Arthroplasty
• Arthroscopy should be reserved for mechanical
  symptoms

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Conclusion

• Evidence in favour of this type of surgery is
  either historical or retrospective
• Recent studies have cast serious doubt on the
  justification for arthroscopic surgery for any
  reason other than mechanical symptoms
• Modern radiological techniques and equipment have
  made accurate diagnosis easier

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Result

• With time, support, access to the simulator and
  theory training it would be possible to learn how
  to do diagnostic arthroscopies
• However, based on current evidence, it is not a
  justifiable option