The reasons why many patients seemingly benefit from arthroscopic treatment of osteoarthritis of the knee remain obscure. The purpose of this pilot study was to determine if a placebo effect might play a role in arthroscopic treatment of this condition. After giving full informed consent, including full knowledge of the pos sibility and nature of a placebo surgery, five subjects were randomized to a placebo arthroscopy group, three subjects were randomized to an arthroscopic lavage group, and two subjects were randomized to a standard arthroscopic debridement group. The physi cians performing the postoperative assessment and the patients remained blinded as to treatment. Patients who received the placebo surgery reported decreased frequency, intensity, and duration of knee pain. They also thought that the procedure was worthwhile and would recommend it to family and friends. Thus, there may be a significant placebo effect for arthroscopic treatment of osteoarthritis of the knee. The small num bers in this preliminary study preclude a valid statistical analysis, and no conclusions can be drawn regarding the superiority of one treatment over another. A larger study is needed to evaluate fully the efficacy of an arthroscopic procedure for this condition and to decide if it is reasonable to expend health care resources for
References
1.
Altman RD, Gray R. Diagnostic and therapeutic uses of the arthroscope in rheumatoid arthritis and osteoarthritis Am J Med7550-55, 1983
2.
Anderson JK, Goldstein WM Arthroscopy in patients over the age of 50 years Am J Arthroscopy1(8) 15-18, 1991
3.
Baumgaertner MR, Cannon WD Jr, Vittori JM, et al Arthroscopic debridement of the arthritic knee Clin Orthop253197-202, 1990
4.
Bert JM, Maschka K. The arthroscopic treatment of unicompartmental gonarthrosis A five-year follow-up study of abrasion arthroplasty plus arthroscopic debridement and arthroscopic debridement alone Arthroscopy525-32, 1989
5.
Burks RT Arthroscopy and degenerative arthritis of the knee A review of the literature . Arthroscopy643-47, 1990
6.
Burman MS, Finkelstein H., Mayer L. Arthroscopy of the knee joint J Bone Joint Surg16255-268, 1934
7.
Casscells SW What, if any, are the indications for arthroscopic debridement of the osteoarthritic knee? Arthroscopy6169-170, 1990
8.
Chandler EJ Abrasion arthroplasty of the knee Contemp Orthop11(2) 21-29, 1985
9.
Chang RW, Falconer J., Stulberg SD, et al A randomized, controlled trial of arthroscopic surgery versus closed needle joint lavage for patients with osteoarthritis of the knee Arthritis Rheum36289-296, 1993
10.
Cobb LA, Thomas GI, Dillard DH, et al An evaluation of internal-mammary-artery ligation by a double blind technic N Engl J Med2601115-1118, 1959
11.
Dandy DJ Arthroscopic debridement of the knee for osteoarthritis J Bone Joint Surg73B877-878, 1991
12.
Dandy DJ Abrasion chondroplasty Arthroscopy251-53, 1986
13.
Daut RL, Cleeland CS, Flanery RC Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases Pain17197-210, 1983
14.
Davis P., Bocell JR, Tullos HS, et al: Arthroscopic treatment in the presence of osteoarthritis of the knee. Orthop Trans14. 568, 1990
15.
Dimond EG, Kittle CF, Crockett JE Comparison of internal mammary artery ligation and sham operation for angina pectoris Am J Cardiol5483-496, 1960
16.
Evans FJ Expectancy, therapeutic instructions and the placebo response, in White L, Tursky B, Schwartz GE (eds) Placebo New York, Guilford Press , 1985, pp 215-228
17.
Ewing JW Arthroscopic treatment of degenerative meniscal lesions and early degenerative arthritis of the knee, in Ewing JW (ed) Articular Cartilage and Knee Joint Function Basic Science and Arthroscopy New York, Raven Press , 1990, pp 137-145
18.
Friedman MJ , Berasi CC, Fox JM, et al Preliminary results with abrasion arthroplasty in the osteoarthritic knee Clin Orthop182200-205, 1984
19.
Gambardella RA Arthroscopic management of the osteoarthritic knee Technique Orthop2(2) 73-77, 1987
20.
Goldman L., Caldera DL, Nussbaum SR, et al Multifactorial index of cardiac risk in noncardiac surgical procedures N Engl J Med297845-850, 1977
21.
Gross DE, Brenner SL, Esformes I., et al: Arthroscopic treatment of degenerative joint disease of the knee Orthopedics141317-1321, 1991
22.
Harwin SF The role of arthroscopic debridement in treatment of the degenerative knee . Orthop Spec Edition 2(7) 7-10, 1993
23.
Ike RW Refractory knee arthritis When to consider arthroscopy J Musculoskel Med8(4) 45-61, 1991
24.
Insall JN, Dorr LD, Scott RD, et al Rationale of the Knee Society clinical rating system Clin Orthop24813-14, 1989
25.
Jackson RW Arthroscopic treatment of degenerative arthritis, McGinty JB (ed) Operative Arthroscopy New York, Raven Press, 1991, pp 319-323
26.
Jackson RW The role of arthroscopy in the management of the arthritic knee Clin Orthop10128-35, 1974
27.
Jackson RW, Silver R., Marans H. Arthroscopic treatment of degenerative joint disease Arthroscopy2114, 1986
28.
Jennings JE Arthroscopic debridement as an alternative to total knee replacement Arthroscopy2123-124, 1986
29.
Johnson LL Arthroscopic abrasion arthroplasty historical and pathologic perspective Present status Arthroscopy254-69, 1986
30.
Kozinn SC, Scott RD Surgical treatment of unicompartmental degenerative arthntis of the knee Rheum Dis Clin North Am14545-564, 1988
31.
Livesley PJ , Doherty M., Needoff M., et al Arthroscopic lavage of osteoarthritic knees J Bone Joint Surg73B922-926, 1991
32.
McGinty JB, Johnson LL, Jackson RW, et al Uses and abuses of arthroscopy A symposium J Bone Joint Surg74A1563-1577, 1992
33.
McLaren AC, Blokker CP, Fowler PJ, et al Arthroscopic debridement of the knee for osteoarthrosis Can J Surg34595-598, 1991
34.
Meenan RF, Mason JH, Anderson JJ, et al AIMS2 The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis Rheum351-10, 1992
35.
Miller RD (ed) Anesthesia Third edition New York, Churchill Livingstone, 1990, p 723
36.
Novak PJ, Bach BR Jr Selection criteria for knee arthroscopy in the osteoarthritic patient Orthop Rev22. 798-804, 1993
37.
Ogilvie-Harris DJ, Fitsialos DP Arthroscopic management of the degenerative knee Arthroscopy7151-157, 1991
38.
Rand JA Role of arthroscopy in osteoarthritis of the knee Arthroscopy7358-363, 1991
39.
Rand JA Arthroscopy and articular cartilage defects Contemp Orthop11(4) 13-26, 1985
40.
Richards RN , Lonergan RP Arthroscopic surgery for relief of pain in the osteoarthritic knee Orthopedics71705-1707, 1984
41.
Robinson D. , Matz E., Halperin N. Arthroscopy of the knee in the geriatric patient Contemp Orthop19373-376, 1989
42.
Ruffin MT IV, Hunter RE Arthroscopy in the geriatric patient JAm Genatr Soc37977-979, 1989
43.
Salisbury RB , Nottage WM, Gardner V. The effect of alignment on results in arthroscopic debridement of the degenerative knee Clin Orthop198268-272, 1985
44.
Schonholtz GJ Arthroscopic debridement of the knee joint Orthop Clin North Am20257-263, 1989
45.
Shahriaree H. Arthroscopic debridement, in Shahriaree H (ed) O'Conner's Textbook of Arthroscopic Surgery Second edition Philadelphia, JB Lippncott Co, 1992, pp 433-436
46.
Singh S., Lee CC, Tay BK Results of arthroscopic abrasion arthroplasty in osteoarthritis of the knee joint Singapore Med J3234-37, 1991
