TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA

1
TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA
INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES
2
TRATAMIENTO ARTROSCOPICO DE LA ARTOSIS DE RODILLA

• La Población tiende a mantenerse físicamente
  cada vez mas activa y a realizar actividades mas
  demandante a edades mas avanzadas
• Artroscopia aparece como un procedimiento mas
  simple en paciente que por edades o cambios
  degenerativos menores no son candidatos a una
  artroplastia

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
3
Cuáles son los objetivos de una Artroscopia?
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
4
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
5
Artrosis de Rodilla
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
6
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
7
El tratamiento de la artrosis de rodilla

• Debe ser etapificado
• Existir relación con síntomas y signos
• Se debe comenzar con medidas simples
• Bajar de peso
• Modificación de la Actividad
• Calzado amortiguador
• kinesioterapia

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
8

• Los pacientes que no presente una respuesta
  favorable al tratamiento conservador, el
  tratamiento quirurgico es una alternativa con
  mejores resultados en pacientes entre 40- 60 años

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
9
Tratamiento Quirúrgico
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
10
Selección de paciente ycriterio para una
Artroscopia
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
11
Tecnica quirurgica
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
12
El procedimiento básicamente incluye

• El aseo articular para dilución de la
  concentración de enzimas degradativas y remoción
  de productos irritantes de la degeneración
  condral, meniscal o sinovial
• Remoción de cuerpos libres intrarticulares
• Meniscectomia parcial

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
13
Meniscectomia

• El proceso patológico de la artrosis en etapas
  tardías no solo genera la destrucción del
  cartílago articular, sino que afecta también la
  integridad de meniscos y ligamentos
• Cualquier procedimiento sobre el menisco debe ir
  orientado a mejorar la sintomatología del
  paciente

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
14

• Un desgarro en un menisco con cambios
  degenerativos esta asociado a cambios
  estructurales preexistentes en el cartílago
  articular que pueden representar una etapa
  temprana de artrosis
• Dependiendo de cuanta funcionalidad meniscal se
  pierda con un desgarro o una resección
  quirúrgica, la artrosis se puede acelerar a
  medida que aumenta la carga biomecánica en el
  cartílago articular

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
15

• La reseccion de una lesion de cuerpo posterior
  del meniso interno disminuye en dos tercios la
  capacidad de absorcion de carga
• Se debe evitar la reseccion del menisco hasta la
  periferia, ya que elima la capacidad del menisco
  de soportar cargas

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
16

• La extrusión meniscal es otro hallazgo común en
  pacientes mayores y es a menudo otro signo de una
  degeneración meniscal y artrosis preexistente
• Una extrusión meniscal puede contribuir a
  aumentar la estrechez del espacio articular

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
17
Condroplastia

• La radiofrecuencia ha ganado popularidad como
  herramienta artroscopica
• Sus ventajas son
• - Fácil de aplicar
• -Bajo costo
• - Retracción del colágeno

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
18

• Estudios han demostrado que la condroplastia
  utilizando radiofrecuencia obtiene superficies
  lisas que permanecen estables por largos periodos
  de tiempo
• Sin embargo, la radiofrecuencia funciona a través
  del calor y su desventaja esta en que los
  condrocitos son extremadamente sensibles a la
  temperatura

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
19
Sinovectomia y remoción de osteofitos

• En el casos que la artrosis avanzada se acompañe
  de sinovitis significa que provocara derrames
  recurrentes, y la Sinovectomia puede estar
  indicada
• La resección de osteofitos en general no son
  recomendado, por el riesgo de provocar
  hemartrosis

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
20
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
21
Resultados

• 50 a 75 de los paciente con Artroscopia
  refieren una mejoría inicial
• 15 progresa a una artroplastia total de rodilla
  a un año
• 44 presenta una disminución clínica
  significativa del dolor a dos años de seguimiento

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
22

• Spahn et al. Examino los resultados de la
  Artroscopia en pacientes con artrosis medial de
  rodilla

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
23
Sugirio que los factores asociados a mal
pronosticos son

• Tiempo de evolución de la artrosis mayor a 24
  meses
• Obesidad
• Osteofitos mediales
• Espacio articular menor a 5 mm
• Tabaco
• Presencia de defecto condral tibial grado IV y
  necesidad de una Meniscectomia total o subtotal

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
24
No se debiera considerar una Artroscopia
Tienen pocas posibilidades de ser un
procedimiento exitoso
Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
25
Estudios Clinicos

• En el estudio de Framingham sobre indicaciones de
  Meniscectomia en rodilla artrosica describió
• El 56 de los hombres entre 70 y 90 años sin
  sintomatología presenta desgarros meniscales y
  en pacientes con artrosis radiográfica este
  porcentaje aumenta a 82. Sin embargo , la
  relación entre daño meniscal y artrosis es
  compleja

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
26

• Una lesión meniscal en una rodilla sana, puede ,
  eventualmente , llevar al desarrollo de la
  artrosis por perdida de la función meniscal
• Una rodilla artrosica puede presentar un desgarro
  meniscal que acelera el proceso degenerativo
• Esto sugiere que el daño meniscal visible
• en resonancia magnética antecede a
• los cambios visibles del cartílago

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
27
Tecnica preferida por el autor

• Como regla general se debe ser conservador y
  juicioso en las resecciones para preservar al
  máximo las estructuras noble de la función
  articular Cartílago y Menisco
• Toda estructura inestable debe ser resecada y/o
  remodelada en su justa medida teniendo en cuenta
  que los pacientes solo utilizaran sus rodilla en
  AVD y baja demanda

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
28

• Contraindicamos formalmente cualquier tipo de
  procedimiento que base su éxito en respuesta
  reparativas del paciente, fundamentalmente por
  los factores de edad y por la severa alteración
  de la homeostasis articular que limita seriamente
  su respuesta regenerativa por ejemplo
  microfracturas, meniscorresis, etc

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
29

• Normalmente por edad y presencia de factores de
  riesgo utilizamos tratamiento anticoagulante
  profiláctico con HBPM en el postoperatorio
• Uso de kinesiología precoz , con énfasis en la
  movilización, limitación de la respuesta
  inflamatorias, drenaje venoso y linfático,
  mantención trofismo muscular y el uso transitorio
  de descarga en la deambulacion

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of arthroscopic debridement
for osteoarthritis of the knee on healthrelated
quality of life. J bone Joint surgAm
200385a(1)1019. Englud, guermazi, lohmander the
meniscus in knee osteoarthristis. Rheum Dis Clin
N Am 35(2009) 579-590. Moseley JB, Omalley k,
Petersen Nj , et al. A controlled trial of
arthroscopia surge for osteoarthristis of the
knee. N Engl J Med 2002347 81-8. Vega J, Golano
P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep
22(9) 1028. E 1-3
30
Conclusión

• La evidencia es categórica en demostrar que el
  tratamiento artroscopico no presenta beneficios
  sobre el tratamiento conservador
• Siempre se debe tomar cuenta que al momento de
  evaluar al paciente que los peores resultados de
  una Artroscopia en artrosis se asocia a mal
  alineamiento , inestabilidades, artrosis
  avanzadas , sintomatología crónica, cirugías
  previas

Aaron RK, Skolnick AH, Reinert Se,et
al.Arthroscopic debridement for osteoarthritis of
the knee.J Bone joint surg am 200688936-43.Berns
tein j, quaccht a perspective on the study of
moseley et al questioning the value of
arthroscopic knee sugery for osteoarthristis.cleve
clin j med.200370(5)405-406-410. Bin SI,Lee
SH,Kim CW,Kim th, lee dh results of arthroscopic
medial meniscectomy in patient with grabe
Ivosteoarthritis of the medial compartment.Arthros
copy 2008 Mar,24(3)264-8. Brian j.cole
MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable
corticosteroids in modern practice.J Am acad
Orthop surg 20051337-46. Cook JL, Kuroki k,
kenter k, marberry k, brawner t, Geiger t,
jayabalan P, bal Bs. Bipolar and monopolar
radiofrequency treatment of osteoarthritic knee
articular cartilage acute and temporal effects
on caartillage compressive stiffnes,
permeability, cell synthesis, and extracellular
matrix composition.J knee surg 2004 apr 17(2)
99-108. David D Waddell, MD, and jack M bert MD.
The use of hyaluronan after arthroscopic surgery
of yhe knee.Artroscopy, vol 26, no 1 ( January),
2010pp105-111.Dearing j,nutton RW evidence based
factors influencing outcome of arthroscopy in
osteoarthritis of the knee. Knee
200814(3)159-63. Dervin Gf, stiell IG, rody k,
grabowski J. effect of art