Arthroscopic surgery and a new classification system.

Arthroscopic lavage and debridement is of significant value in the earlier stages of arthritis. This is probably through the removal or dilution of enzymes that are part of the degradative process of osteoarthritis. Mechanical problems such as meniscal tears and loose bodies also can be addressed at the same time. However, patients must be selected carefully for arthroscopic treatment. A severity scale is proposed based on clinical and radiological findings that should indicate in advance those patients who will have the greatest opportunity for improvement from an arthroscopic procedure. Critics have said that lavage and debridement does nothing to change the natural history of the disease and is no more than a placebo effect. While there is no strong evidence to suggest that it does modify the natural history of the disease, it definitely improves the quality of life for a significant period of time, with little in the way of complications or morbidity associated with the procedure. The placebo effect might explain some of the results, but the placebo effect is well-known in medicine, and if it does produce a positive result in terms of reduction of symptoms, it cannot be entirely discounted. The biological resurfacing of a joint under arthroscopic control is the challenge facing orthopedic surgeons today. Healing and restoration of articular tissues back to some functional biological state would seem to be a reasonable goal. If this can be achieved, the future will lie in the salvage of joints through arthroscopic procedures rather than the replacement of joints by arthroplasty.