Should Surgeons Debride Chondral Lesions Found During Arthroscopic Partial Meniscectomy?
Maybe not, according to a recently published study that reported no benefit at 1 year for partial meniscecomy plus debridement versus partial meniscectomy alone. And, debridement may even hamper recovery in the short term.
Shaleen Vira, MD, and Mehul R. Shah, MD
Bisson LJ, Kluczynski MA, Wind WM, Fineberg MS, Bernas GA, Rauh MA, Marzo JM, Zhou Z, Zhao J. Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial. J Bone Joint Surg Am. 2017 Jul 5;99(13):1078-1085.
When performing an arthroscopic partial meniscectomy, the surgeon may identify unstable chondral lesions. Addressing these lesions with debridement is common. However, the impact of debridement plus partial meniscectomy versus partial meniscectomy alone on the patient’s postoperative functional status has not been rigorously studied.
In this randomized controlled trial by Bisson et al, 161 patients undergoing partial meniscectomy who had unstable chondral lesions were randomized to either partial meniscectomy with concomitant debridement of the lesions (n=83) or partial meniscectomy alone (n=78). The primary outcome measure was knee pain at 1 year after surgery. Secondary outcome measures included knee functional scores, range of motion, and quadriceps circumference. The mean age of the cohort was 54 years, with no differences between the groups with respect to this or any other demographic variables.
No major long-term differences in pain and physical function scores were seen between groups at 1 year after surgery. However, patients in the partial meniscectomy alone group experienced more short-term improvement in physical functional scores and quadriceps circumference.
As a result, Bisson et al suggest that in the short term, concomitant debridement of unstable chonodral lesions may delay recovery in patients undergoing partial meniscectomy. In the long term, debridement seems to offer no advantage.
Arthroscopic partial meniscectomy is one of the most commonly performed procedures in orthopaedics. The study by Bisson et al is the first to present Level 1 data on the value of addressing unstable chondral lesions during knee arthroscopy for partial meniscectomy. The authors conclude that observation of these lesions should be the new practice, as debridement demonstrates no benefit in pain and function at 1 year.
This study has several limitations:
- First, size of the chondral lesions and impending loose body status were not sub-analyzed for their effect on outcomes.
- Second, the authors did not study potential secondary operations to address these chondral defects.
- Third, the sample size and duration of follow-up limit our understanding of the long-term implications of simply observing unstable chondral lesions found during arthroscopy.
Nevertheless, this study has the potential to change practice, as it may prompt clinicians reconsider or increase their threshold for debridement of unstable chondral lesions during routine knee arthroscopy.
Shaleen Vira, MD, is a resident physician at NYU Langone Orthopaedic Hospital, New York, New York. Mehul R. Shah, MD, is an Assistant Professor of Orthopaedic Surgery, Division of Sports Medicine, at NYU Langone Orthopaedic Hospital, New York, New York.
The authors have no disclosures relevant to this article.