Australian Knee Society



Arthroscopic debridement, and / or lavage, has been shown to have no beneficial effect on the natural history of osteoarthritis, nor is it indicated as a primary treatment in the management of osteoarthritis. However, this does not preclude the judicious use of arthroscopic surgery, when indicated, to manage symptomatic coexisting pathology, in the presence of osteoarthritis or degeneration. Partial medial meniscectomy is not indicated as an initial treatment for atraumatic tears of degenerative menisci, excluding bucket handle tears and surgeon assessed locked or locking knees.

Arthroscopic Surgery in the Presence of Osteoarthritis or Degeneration

There are certain clinical scenarios in which arthroscopic surgery, in the presence of osteoarthritis, may
be appropriate. These include, but are not necessarily limited to, the following:

  • known or suspected septic arthritis
  • symptomatic non-repairable meniscal tears after failure of an appropriate trial of a
    structured rehabilitation program
  • symptomatic loose bodies
  • surgeon assessed locked or locking knees
  • traumatic or atraumatic meniscal tears that require repair
  • inflammatory arthropathy requiring synovectomy
  • synovial pathology requiring biopsy or resection
  • large unstable chondral pathology causing surgeon assessed locking or locked knee
  • as an adjunct to, and in combination with, other surgical procedures as appropriate for
    osteoarthritis: for example high tibial osteotomy and patello-femoral realignment
  • diagnostic arthroscopy when the diagnosis is unclear on MRI or MRI is not possible, and the
    symptoms are not of osteoarthritis
    The decision to proceed with arthroscopic surgery in the presence of osteoarthritis or degeneration should be
    made by the treating orthopaedic surgeon:
  • after careful review of the clinical scenario: particularly the assessment of the relative contributions
    of the osteoarthritis, and the arthroscopically treatable pathology, to the patient’s symptoms
  • with knowledge of the relevant evidence base, as listed in this document
  • after an appropriate trial of structured rehabilitation
  • and after thoughtful discussion with the patient about the relative merits of the procedure versus
    ongoing non-operative treatment

October 2016

Executive Summary

A detailed history and examination, followed by a standardised series of plain radiographs where indicated, remains the cornerstone methodology to the clinical diagnosis of knee osteoarthritis.

The Australian Knee Society (AKS) is concerned about the increasing use of the LARS device for anterior cruciate ligament reconstruction in the absence of sufficient evidence to support its widespread use.

In a 2011 survey of members of the AKS the majority considered that this device does not heal to bone, may cause articular surface damage (with possible premature arthritis), and will fail as have other synthetic ligaments.

The view of the AKS is that the use of the LARS device should be limited to those surgeons who follow specific indications and will follow up and report their results to an appropriate meeting of their peers such as the AKS or Australian Orthopaedic Association.

March 2011

In 2010 the AKS was consulted to provide guidance to the Australian Orthopaedic Association on what advice it may give, if asked by any of its members, or members of the public, any questions regarding the burgeoning use of the LARS device for ACL reconstructive surgery. A survey of AKS members was conducted in December 2010. As a result of that survey, a consensus position statement was developed in March 2011.

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For general enquiries, please email

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