[Results of arthroscopic debridement and lavage in patients with knee osteoarthritis]. / Resultados obtenidos con la limpieza articular artroscópica de rodilla en pacientes con osteoartritis.

INTRODUCTION: Knee osteoarthritis (OA) is a degenerative process that affects people over 50 years old and is an important cause of disability. Treatment options include non-operative and operative modalities. Arthroscopic lavage and debridement may be the first choice to consider in patients between 45 and 65 years with early OA. MATERIAL AND METHODS: We conducted a self-controlled clinical trial with deliberate maneuver assignment. Thirty nine patients between 38 and 68 year of age with clinical and radiographic knee OA were included. Patients underwent arthroscopic lavage and debridement between January of 2001 and December 2003. Preoperative and postoperative evaluation was performed using the HSS knee score as well as questions that evaluated patient satisfaction and subjective function. Statistical analysis using one tailed Student's t-test was performed. Significance was considered with ap value of < 0.0001. RESULTS: Thirty-three patients completed the evaluation. Six patients were lost to follow-up. Mean age of patients was 53 (38 to 68). Mean preoperative HSS score was 54.9 and average postoperative score was 74.8. Thirty-one out of 33 patients (93%) were satisfied and reported good subjective function after the operation. Twenty five of these patients presented Outerbridge grade II-III cartilage defects and 6 patients presented grade IV lesions. Twenty nine of the 33 patients (87.8%) referred improvement to perform their daily-living activities and 4 patients did not improve. Thirty two out of 33 patients would recommend the operation. DISCUSSION: Arthroscopic debridement and lavage improves function and satisfaction in patients with grade II and III of OA. Patients with severe chondral lesions (grade IV) also improved to a lesser extent. Thus, arthroscopic debridement and lavage is a good treatment alternative in young patients with early OA.

[Cartilage repair: cell-based techniques]. / Reparación del cartílago articular: técnicas basadas en cultivos celulares.

INTRODUCTION: The field of cartilage repair continues to advance after cell based and single-stage chondrocyte transplantation technologies. These strategies have been widely used in developed countries, and clinical, histologic and functional outcomes are of special interest. OBJECTIVE: To describe evidence of cartilage repair techniques by means of a literature review. RESULTS AND DISCUSSION: Cartilage restoration through osteochondral allografting or autologous chondrocyte implantation (ACI) had proven efficacy, but technical and biologic limitations to these procedures exist. However, newer second-generation and third-generation cell-based technologies are being developed and tested clinically with purposes of decreasing operative morbidity, the ability to use a single-stage approach, and improve the viability and durability of cartilage repair tissue. These techniques can be used for treatment of important chondral defects in young patients and elite athletes, but well-designed randomized clinical trials should be done to confirm the value of these procedures.