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Randomized Controlled Trial
. 2017 Jul 5;99(13):1078-1085.
doi: 10.2106/JBJS.16.00855.

Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial

Leslie J Bisson  1 , Melissa A Kluczynski, William M Wind, Marc S Fineberg, Geoffrey A Bernas, Michael A Rauh, John M Marzo, Zehua Zhou, Jiwei Zhao
Affiliations
Randomized Controlled Trial

Patient Outcomes After Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: The Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial

Leslie J Bisson et al. J Bone Joint Surg Am. .

Abstract

Background: It is unknown whether unstable chondral lesions observed during arthroscopic partial meniscectomy (APM) require treatment. We examined differences at 1 year with respect to knee pain and other outcomes between patients who had debridement (CL-Deb) and those who had observation (CL-noDeb) of unstable chondral lesions encountered during APM.

Methods: Patients who were ≥30 years old and undergoing APM were randomized to receive debridement (CL-Deb group; n = 98) or observation (CL-noDeb; n = 92) of unstable Outerbridge grade-II, III, or IV chondral lesions. Outcomes were evaluated preoperatively and at 8 to 12 days, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) pain score, Short Form-36 (SF-36) health survey, range of motion, quadriceps circumference, and effusion. The primary outcome was the WOMAC pain score at 1 year. T tests were used to examine group differences in outcomes, and the means and standard deviations are reported.

Results: There were no significant differences between the groups with respect to any of the 1-year outcome scores. Compared with the CL-Deb group, the CL-noDeb group had improvement in the KOOS quality-of-life (p = 0.04) and SF-36 physical functioning scores (p = 0.01) as well as increased quadriceps circumference at 8 to 12 days (p = 0.02); had improvement in the pain score on the WOMAC (p = 0.02) and KOOS (p = 0.04) at 6 weeks; had improvement in SF-36 physical functioning scores at 3 months (p = 0.01); and had increased quadriceps circumference at 6 months (p = 0.02).

Conclusions: Outcomes for the CL-Deb and CL-noDeb groups did not differ at 1 year postoperatively. This suggests that there is no benefit to arthroscopic debridement of unstable chondral lesions encountered during APM, and it is recommended that these lesions be left in situ.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
Arthroscopic photograph of a lesion that was considered an impending loose body.
Fig. 2
Fig. 2
The ChAMP Trial sample flowchart.
Fig. 3
Fig. 3
The WOMAC pain scores by study group and study visit (without imputation for missing data). The asterisk indicates that there was a significant difference between the groups at 6 weeks (p = 0.02). SD = standard deviation.
Fig. 4
Fig. 4
The WOMAC pain scores by study group and study visit (with imputation for missing data). The asterisk indicates that there was a significant difference between the groups at 6 weeks (p = 0.01). SD = standard deviation.
See this image and copyright information in PMC

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