Kirkley arthroscopy for knee OA

A randomized trial of arthroscopic surgery for osteoarthritis of the knee.

Kirkley A, Birmingham TB, Litchfield RB, et al. The New England journal of medicine 2008 · PMID 18784099 · doi:10.1056/nejmoa0708333

Question

Does arthroscopic lavage and debridement added to optimised physical and medical therapy improve outcomes in knee osteoarthritis?

Design

Single-centre RCT in Canada with 2-year follow-up.

Patients

Adults with moderate-to-severe knee osteoarthritis (excluding large bucket-handle tears).

Intervention

Arthroscopic lavage and debridement plus optimised physical and medical therapy

Comparison

Optimised physical and medical therapy alone

Primary outcome

Total WOMAC score at 2 years

Key result

Adding arthroscopic surgery gave no significant additional benefit in WOMAC score at 2 years over physical and medical therapy alone.

Limitations

Single centre and unblinded; excluded patients with large bucket-handle tears causing true locking.

Impact on practice

Underpins NICE guidance not to refer for arthroscopic lavage and debridement in knee osteoarthritis unless there is a clear history of mechanical locking.