Knee arthoroscopy

What is surgery for degeneration of the knee joint and surrounding tissues?

The most common cause of generalised knee pain is degenerative joint disease, commonly known as osteoarthritis. Osteoarthritis of the knee can result in the shock-absorbing cartilage, which cushions the knee joints, becoming inflamed, breaking down and eventually being lost.

Symptoms include pain and stiffness, and may include mechanical giving way, clicking or locking. These may impair a patient’s ability to perform activities of daily living and recreational activities.

Conservative treatments are aimed at reducing the symptoms. These conservative treatments can include the following: weight loss and physical therapy. National guidance advises that pain relief medication and physiotherapy, may also be beneficial.

Not normally funded treatment or procedure

Arthroscopic knee surgery is a treatment which may include:

  • Arthroscopic lavage (also called ‘arthroscopic washout’)
  • Arthroscopic debridement (in combination with lavage) AND
  • Arthroscopic partial meniscectomy (APM) which may be performed singly or in combination with debridement and lavage.

An arthroscopic knee washout involves flushing the joint with fluid, which is introduced through small incisions in the knee. The procedure is often done with debridement, which is the removal of loose debris around the joint. The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint. They can be damaged or torn during activities that put pressure on or rotate the knee joint. Meniscectomy is the surgical removal of all (total menisectomy) or part (partial menisectomy) of a torn meniscus.

Advice and guidance

Knee arthroscopic lavage and debridement, with or without partial meniscectomy, will not be routinely commissioned for patients with degenerative knee disease (with or without radiographic and other symptoms of osteoarthritis, meniscus tears and mechanical symptoms).

This is because there is published evidence showing that arthroscopic debridement with or without partial meniscectomy is not superior to conservative management.

The term degenerative knee disease is used to explicitly include patients with knee pain, particularly if they are more than 35 years old, with or without:

  • Imaging evidence of osteoarthritis
  • Meniscus tears
  • Locking, clicking, or other mechanical symptoms except persistent objective locked knee
  • Acute or subacute onset of symptoms.

Symptoms include pain and stiffness, and may include mechanical giving way, clicking or locking. These may impair a patient’s ability to perform activities of daily living and recreational activities.

Conservative treatments aimed at reducing the symptoms include patient information, weight loss and physical therapy.

NICE advises that pain relief medication, physiotherapy, arthrocentesis and intra-articular corticosteroid injections may also be beneficial if the pain is moderate to severe.

Treatment policy for patients covered by NHS Birmingham and Solihull CCG