Let Unstable Chondral Lesions Be During Partial Meniscectomy

More than 900,000 patients every year undergo knee arthroscopy in the US. Many of those procedures involve a partial meniscectomy to address symptomatic meniscal tears. Surgeons “scoping” knees under these circumstances often encounter a chondral lesion—and most proceed to debride it.

However, in the July 5, 2017 issue of JBJS, Bisson et al. report on a randomized controlled trial that suggests there is no benefit to arthroscopic debridement of most unstable chondral lesions when they are encountered during partial meniscectomy. With about 100 patients ≥30 years old in each group, the authors found no significant differences in function and pain outcomes between the debridement and observation groups at the 1-year follow-up. In fact, relative to the debridement group, the observation group had more improvement in WOMAC and KOOS pain scores at 6 weeks, better SF-36 physical function scores at 3 months, and increased quadriceps circumference at 6 months.

The authors conclude that these findings “challenge the current standards” of typically debriding chondral lesions in the setting of arthroscopic partial meniscectomy. They also surmise that, in conjunction with declining Medicare reimbursements for meniscectomies with chondral debridement, these results “may lead to a reduction in the rate of arthroscopic debridement.”