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Arthroscopic debridement

'Debridement' is a rather broad term, encompassing sucking up loose fronds of synovium (joint lining), meniscus or cruciate ligament and sucking out any joint debris. Arthroscopic debridement means that this is done using keyhole surgery, where a thin 'scope' is pushed into the joint (arthro=joint) to visualise the structures.

It may be a trivial part of the surgical procedure or, if there is florid synovitis (joint lining inflammation), it may be extensive.

Excessive growth of irritated synovium leads it to multiply its surface area by buckling into fronds, and the fronds may become inflamed and pour destructive enzymes into the joint space, leading to joint swelling and joint surface destruction. ‘Hoovering’ away this excessive material, and washing out any debris (lavage), frequently settles down an irritable knee.

A ragged meniscus or cruciate ligament may also be debrided.

Joint cartilage restoration

Arthroscopic debridement is part of an armamentarium of procedures which are now available to help reverse the damage of early arthritis:

• lavage, debridement
• abrasion arthroplasty, sub chondral drilling, microfracture
• osteochondral allograft and autograft (OATS procedure, mosaicplasty, paste grafting)
• autologous chondrocyte implantation (ACI or MACI) or transplantation (ACT)

There is, however, controversy about the value of simple lavage and debridement for the older patient with established osteoarthritis.