Knee Articular Cartilage Debridement in Conjunction With Partial Meniscectomy

Study Overview
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Brief Summary
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The aim of this study is to describe changes at the site of the study patient's articular cartilage lesion on the femoral condyle with multiple magnetic resonance imaging (MRI) outcomes 6 months after treatment using one of three standard surgical treatment methods: 1) lavage debridement; 2) mechanical debridement; 3) mechanical and radiofrequency-based debridement.

Detailed Description
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Fibrillated articular cartilage are commonly detected during arthroscopy when treating knee pathologies such as a torn meniscus or a damaged anterior cruciate ligament (ACL). The severity of these lesions is graded using a scheme such as the International Cartilage Research Society (ICRS) classification system. Grade I lesions are often left untreated, while Grade IV lesions require dedicated surgical intervention. Grade II and III lesions are frequently treated when they are encountered arthroscopically. Currently, it is not known whether treatment of fibrillated articular cartilage is beneficial or whether one procedure is superior to another. Magnetic resonance imaging is the best technique currently available for non-invasive assessment of chondral lesions. The primary aim of the proposed study is to compare post-procedure MR imaging characteristics of fibrillated articular cartilage treated using one of the three standard of care measures: 1) Washing of the knee joint with saline solution to clear blood, fluid or loose tissue (also known as lavage); 2) Lavage in addition to mechanical shaver (a manual surgical tool used by the study doctor); and 3)Lavage in addition to the Paragon device (RF-based microdebridement), which may also be used with a mechanical (or manual) surgical tool. The secondary aim is to determine the association between imaging features and clinical outcomes.

Official Title
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Magnetic Resonance Imaging and Clinical Outcomes After Three Different Treatments for Articular Cartilage Lesions Concomitant With Partial Meniscectomy

Conditions
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Torn Meniscus

Intervention / Treatment
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* Device: Mechanical debridement
* Device: Paragon T2
* Procedure: Lavage debridement
* Device: Mechanical Debridement
* Device: RF- based Debridement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria:Screening Age between 18 and 60 years BMI <35 Meniscal tear (medial or lateral) diagnosed by H+P exam and/or imaging in the index knee No severe joint space narrowing (IKDC Classification) seen on weight-bearing AP X-ray in the index knee No avascular necrosis in the index knee as evidenced by preop MRI obtained within 6 months prior to randomization No Varus (>10 degrees) or Valgus (>15 degrees)knee deformities as seen by AP X-ray in the index knee Minimal or no abnormality of contralateral knee as shown by clinical exam and/or imaging Candidate for unilateral arthroscopic treatment of the knee Visual Analog Scale (VAS) pain score of 30 mm or greater in the index knee at the time of screening Must be able to undergo MRI at required time points per appendix D Physically and mentally willing and able to comply with study requirements Must be willing and able to follow the standardized rehabilitation protocol (Appendix C) Subject must sign IRB approved informed consent form Arthroscopy Inclusion Criteria: Arthroscopic confirmation of ICRS Grade II or III chondral lesion on the medial or lateral femoral condyle Exclusion Criteria: Screening Knee instability, malalignment, or patellar tracking dysfunction in the index knee Inflammatory rheumatoid arthritis or other systemic inflammatory arthritis in the index knee or contralateral knee Previous total meniscectomy in the index knee Previous surgical treatment of the index knee by arthroscopy less than 2 years prior to treatment by this study Previous total meniscectomy Previous knee tendon and/or ligament repair or patellar surgery of index knee Previous microfracture or bone marrow stimulation of the index knee Previous unsuccessful osteotomy in the index knee Presence of fractures, osteocysts or osteolysis in the index knee Presence of osteoarthritis in the index knee Pre-existent osteoarthritis of weight-bearing joints (e.g. hips or contralateral knee) that adversely affects gait Participation in another clinical study Terminally ill Drug therapy for the index knee with systemic steroid therapy, steroid intra-articular therapy or intra-articular hyaluronic acid therapy within 2 months of enrollment into this study Receiving narcotic pain medication by prescription for other conditions unrelated to knee injury Contralateral knee involvement causing abnormal ambulation and non-compliance with rehabilitation Pregnant or suspected pregnant Coagulation disorder or patient is receiving anti-coagulants, which cannot be safely stopped for 14 days (7 days prior to surgery and 7 days post-surgery) Arthroscopy Exclusion Criteria: Presence of Grade IV chondromalacia anywhere in the index knee ACL, PCL or MCL tear of the index knee Osteochondritis dissecans (OCD)of the index knee Meniscal tear requiring total meniscectomy Evidence of osteoarthritis in the index knee

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Lavage debridement to remove loose fragments<br>Articular cartilage defect left untreated by surgical tool during partial meniscectomy | Procedure: Lavage debridement<br>* Remove loose chondral fragments<br>|
| Active Comparator: Mechanical Debridement<br>Remove large chondral flaps and loose fragments | Device: Mechanical debridement<br>* Mechanical shaver will be used to remove large chondral flaps and loose fragments<br>Device: Mechanical Debridement<br>* Use of a mechanical device such as a shaver, punch, or biter to remove large chondral flaps and loose fragments<br>|
| Active Comparator: RF based Debridement<br>Debridement to remove loose fragments followed by use of Paragon T-2 RF wand to smooth the base of the shoulder of the tear | Device: Paragon T2<br>* Use Paragon device to debride after removal of larger chondral lesion flaps with mechanical shaver.<br>Device: RF- based Debridement<br>* Use of debridement device to remove large fragments followed by use of RF-based debridement to smooth the base of the shoulder of the tear.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In vivo magnetic resonance imaging (MRI) features of the femoral condyle chondral lesion |  | 6 months after arthroscopy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine whether recovery from recurrent pain, effusion, localized mechanical symptoms, and quality of life are equivalent for treatment groups |  | Up to 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Partial Meniscectomy, Partial Thickness Knee Tear, MR Imaging, Mechanical Debridement, Crepitus, Stability, Coblation, Bipolar Radiofrequency, Debridement, Recurrent Knee Pain, meniscectomy, meniscus, cartilage lesion, articular cartilage lesion, articular cartilage, knee