Arthroscopic Debridement of the Knee

Arthroscopic debridement is not recommended for osteoarthritis

When you have knee osteoarthritis, it's accepted practice that non-surgical, conservative treatments are tried first when attempting to manage it. When non-surgical treatments fail, it may be time to look into joint surgery. Arthroscopic debridement is one surgical option, but experts have suggested it only be performed on certain patients and for the right reasons.

Doctor examining patient's knee
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Understanding Arthroscopic Debridement

You have likely heard arthroscopic debridement referred to in more general terms, such as arthroscopy, arthroscopic surgery, or scoping the knee. Arthroscopic debridement, specifically, involves using surgical instruments to remove damaged cartilage or bone. The surgeon typically does a washout, called a joint lavage, to remove any debris ​around the affected joint. If loose bodies or fragments remain after the lavage, they are removed.

Not too many years ago, arthroscopic debridement was quite common for osteoarthritis patients who found no relief from conservative treatment. It was almost expected that a doctor would suggest scoping a knee to see what was causing relentless osteoarthritis symptoms. But in 2002, an article published in the New England Journal of Medicine changed how arthroscopic debridement was viewed.

Researchers Question Effectiveness of Arthroscopic Debridement

Some thought arthroscopic debridement worked by flushing fluid through the joint during the procedure to rid the knee of debris and possibly inflammatory enzymes. Others believed the improvement was due to the removal of flaps of cartilage, torn meniscal fragments, synovial tissue, and loose debris. But it really wasn't clear what was happening.

The study results that were published in 2002 surprised many, not the least of whom were patients who swore arthroscopic debridement helped them. Researchers had started to suspect that arthroscopic debridement was no more effective than placebo because they lacked any sound explanation for how or why it worked.

In the study, 180 patients with osteoarthritis of the knee were randomly assigned to receive arthroscopic debridement, arthroscopic lavage, or placebo surgery. At no point during the study did patients in the groups receiving arthroscopic debridement or lavage report less pain or improved joint function compared to the placebo group.

The results of the study had a huge impact and there was confusion over who should be having the surgery. Had patients and insurance companies been paying out big bucks for a procedure that had no more effect than placebo?

Cochrane Review of Arthroscopic Debridement

A Cochrane review of research pertaining to arthroscopic debridement was published in 2008 and offered a bit more insight. Three randomized, controlled trials involving a total of 271 patients were included in the review. In one study, compared to lavage, there was no significant difference found for arthroscopic debridement. Compared to placebo (sham surgery), there were worse outcomes for arthroscopic surgery at 2 weeks in terms of pain and function, and no significant difference at two years.

The second study compared arthroscopic debridement with washout and concluded that arthroscopic debridement significantly reduced knee pain at five years. The third study compared arthroscopic debridement to closed-needle lavage and concluded there was no significant difference.

Other research since then has come to the same conclusion: there isn't enough clinical evidence that arthroscopic debridement is effective for osteoarthritis of the knee and it's not a recommended treatment.

The Bottom Line

The American Academy of Orthopaedic Surgeons (AAOS) incorporated the conclusions into their treatment recommendations for knee osteoarthritis. The AAOS states that it cannot recommend arthroscopic debridement and/or lavage to treat osteoarthritis. This recommendation is based primarily on the above-mentioned 2002 study, along with two other similar studies conducted later. However, the recommendation doesn't apply to people with a primary diagnosis of a meniscal tear, loose body, or other derangements in the knee along with osteoarthritis.

Frequently Asked Questions

  • What is arthroscopic debridement?

    Arthroscopic debridement is a minimally invasive orthopedic surgery that removes damaged cartilage or bone. Also called scoping or arthroscopic surgery, it involves a joint lavage or washout to remove debris around the joint. Any remaining loose fragments are surgically removed. 

  • Does arthroscopic debridement of the knee work to treat osteoarthritis?

    There is no evidence to show arthroscopic debridement is effective in treating osteoarthritis. Several studies found scoping is no more effective placebo treatment. In fact, the American Academy of Orthopedic Surgeons no longer recommends arthroscopic debridement or lavage for osteoarthritis.

  • Can arthroscopic debridement make osteoarthritis worse?

    Possibly. A 2020 study found people who underwent arthroscopic debridement for osteoarthritis in the knee were twice a likely to need a total knee replacement within five years than a control group.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Buttgereit F, Burmester G-R, Bijlsma JWJ. Non-surgical management of knee osteoarthritis: where are we now and where do we need to go? RMD Open. 2015;1(1). doi:10.1136/rmdopen-2014-000027

  2. Law GW, Lee JK, Soong J, Lim JWS, Zhang KT, Tan AHC. Arthroscopic debridement of the degenerative knee - Is there still a role?Asia Pac J Sports Med Arthrosc Rehabil Technol. 2018;15:23–28. doi:10.1016/j.asmart.2018.11.003

  3. Moseley JB, Omalley K, Petersen NJ. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the KneeNew England Journal of Medicine. 2002;347(2):81-88. doi:10.1056/nejmoa013259

  4. Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritisCochrane Database of Systematic Reviews. 2008. doi:10.1002/14651858.cd005118.pub2

  5. American Academy of Orthopedic Surgeons. Treatment of Osteoporosis of The Knee.

  6. Katz JN, Shrestha S, Losina E, et al; METEOR Investigators, Collins JE. Five-year outcome of operative and nonoperative management of meniscal tear in persons older than forty-five years. Arthritis Rheumatol. 2020;72(2):273-281. doi:10.1002/art.41082

Additional Reading

By Carol Eustice
Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis."