Osteoarthritis (OA) of the knee is a progressive degenerative joint disease characterized by cartilage degradation, subchondral bone remodelling, and synovial inflammation, leading to significant pain and functional limitations (1). Total Knee Arthroplasty (TKA) remains the gold standard for end-stage knee OA; however, the increasing demand for joint replacement among younger and more active individuals presents a clinical challenge, as implant longevity remains a concern (2). Early intervention strategies focusing on joint preservation have gained attention to potentially delay the need for TKA and improve patients' quality of life.

Arthroscopy-guided cartilage preservation (AGCP) has emerged as a minimally invasive approach aimed at enhancing joint integrity and promoting cartilage repair (3). Techniques such as debridement, microfracture, and chondroplasty have been employed to alleviate symptoms and facilitate biological healing within the joint environment (4). Furthermore, the application of biological agents such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) has been explored to enhance cartilage regeneration, with encouraging preliminary results (5,6). However, the efficacy of AGCP remains a topic of ongoing research, particularly regarding its ability to delay the progression of osteoarthritis and postpone the need for TKA.

Several studies have reported favorable short-term outcomes following arthroscopic interventions, with improvements in pain relief, joint stability, and functional performance (7,8). However, comprehensive evaluations of AGCP as a preventive strategy for TKA remain limited. Moreover, there is a lack of well-designed randomized clinical trials comparing AGCP with conventional conservative management approaches, particularly in patients with moderate knee osteoarthritis.

The present study aims to evaluate the effectiveness of AGCP in patients with grade II-III knee osteoarthritis, specifically assessing pain relief, functional improvement, and cartilage regeneration as potential factors contributing to delayed TKA. This study hypothesizes that AGCP will result in superior clinical outcomes compared to standard conservative treatment over a 12-month follow-up period.

Study Design and Participants:

A total of 100 patients aged between 40 and 65 years, diagnosed with grade II-III knee osteoarthritis based on the Kellgren-Lawrence grading system, were enrolled. Patients were randomly assigned into two groups: Group A (AGCP group, n=50) and Group B (Conservative Treatment group, n=50). Exclusion criteria included patients with inflammatory arthritis, severe knee deformities, previous knee surgeries, and those contraindicated for arthroscopy. Informed consent was obtained from all participants.

Intervention Protocol:

• Group A (AGCP Group):
  Patients in this group underwent arthroscopy-guided cartilage preservation procedures. The procedures included debridement, microfracture, and chondroplasty, performed under general or spinal anesthesia. Debridement involved the removal of loose cartilage fragments, while microfracture aimed to stimulate subchondral bone marrow to enhance cartilage repair. Chondroplasty was used to smooth irregular cartilage surfaces. All procedures were conducted by experienced orthopedic surgeons using standard arthroscopic techniques. Postoperative rehabilitation included physiotherapy focusing on range-of-motion exercises and gradual weight-bearing activities.
• Group B (Conservative Treatment Group):
  Patients in this group received conventional treatment consisting of physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and lifestyle modification advice. Physiotherapy included muscle-strengthening exercises, aerobic conditioning, and flexibility training.

Outcome Measures:

Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Visual Analog Scale (VAS) for pain. Evaluations were performed at baseline, 6 months, and 12 months post-intervention. KOOS comprises five subscales: Pain, Symptoms, Activities of Daily Living (ADL), Sports and Recreation Function, and Quality of Life (QoL). Higher scores indicate better knee function.

Radiological Assessment:

Magnetic Resonance Imaging (MRI) was performed at baseline and at the 12-month follow-up to assess cartilage integrity and thickness. The changes in cartilage thickness were measured and compared between the groups.

Statistical Analysis:

Data were analyzed using SPSS software version [26]. Descriptive statistics were presented as mean ± standard deviation for continuous variables and percentages for categorical variables. Within-group comparisons were made using paired t-tests, while between-group comparisons were analyzed using independent t-tests and Analysis of Variance (ANOVA). Statistical significance was set at p < 0.05.

A total of 100 patients were enrolled in the study and randomly assigned to two groups: Group A (AGCP group, n=50) and Group B (Conservative Treatment group, n=50). The mean age of participants was 55.2 ± 7.1 years, with no significant difference between the groups (p = 0.68).

Clinical Outcomes

Significant improvements were observed in the KOOS and VAS scores for Group A compared to Group B at 6 months and 12 months follow-up.

Table 1: Comparison of KOOS Scores Between Groups A and B

The KOOS scores showed significant improvement in all subscales for Group A compared to Group B at 12 months (Table 1).

Pain Assessment

VAS scores for pain were significantly reduced in Group A compared to Group B over the follow-up period.

Table 2: Comparison of VAS Scores Between Groups A and B

Group A exhibited a mean reduction of 5.2 points on the VAS scale compared to a 1.8-point reduction in Group B over the study period (Table 2).

Radiological Findings

MRI analysis revealed significant improvement in cartilage thickness in Group A compared to Group B.

Table 3: Changes in Cartilage Thickness (in mm)

The mean increase in cartilage thickness was 1.2 mm for Group A, compared to 0.3 mm for Group B, indicating a significant advantage of the AGCP technique (Table 3).

The present study aimed to evaluate the efficacy of Arthroscopy-Guided Cartilage Preservation (AGCP) in delaying the progression of knee osteoarthritis and postponing the need for Total Knee Arthroplasty (TKA). The findings of this study demonstrated that AGCP significantly improved pain relief, joint function, and cartilage regeneration compared to conventional conservative treatment over a 12-month follow-up period.

The results revealed that patients undergoing AGCP exhibited a substantial improvement in KOOS scores across all subscales, including pain, symptoms, activities of daily living, sports and recreation, and quality of life. This finding is consistent with previous studies highlighting the benefits of arthroscopic interventions in enhancing joint function and reducing pain (1,2). The improved outcomes observed in the AGCP group may be attributed to the restoration of cartilage integrity through microfracture and chondroplasty, which are known to stimulate biological healing and promote cartilage regeneration (3,4).

Pain reduction, as measured by the Visual Analog Scale (VAS), was also significantly greater in the AGCP group compared to the conservative treatment group. This improvement aligns with findings from similar studies that reported notable pain relief following arthroscopic procedures (5,6). The observed pain reduction may be linked to the removal of inflammatory debris during debridement, thereby enhancing joint homeostasis (7). Additionally, the microfracture technique employed in this study likely contributed to the formation of fibrocartilage, which provides a temporary pain-relieving effect (8).

The MRI findings of this study further support the efficacy of AGCP, as patients in Group A demonstrated a mean increase in cartilage thickness of 1.2 mm compared to 0.3 mm in Group B. This result is consistent with previous studies that reported improved cartilage integrity following arthroscopic interventions (9,10). The application of microfracture has been shown to enhance subchondral bone marrow stimulation, promoting the migration of progenitor cells and subsequent cartilage formation (11). Furthermore, chondroplasty smoothens irregular cartilage surfaces, thereby improving joint biomechanics and potentially delaying cartilage degradation (12).

Despite these promising findings, it is essential to acknowledge certain limitations of this study. First, the follow-up period of 12 months may not be sufficient to determine the long-term efficacy of AGCP in delaying the progression to TKA. Second, the study did not incorporate advanced biological agents such as platelet-rich plasma (PRP) or mesenchymal stem cells (MSCs), which have been suggested to enhance cartilage repair and improve clinical outcomes (13,14). Future studies incorporating such biological agents could provide a more comprehensive understanding of the potential benefits of AGCP.

Additionally, the lack of a placebo-controlled group may introduce bias, although the comparison with conventional conservative treatment remains relevant. It is also important to consider that the study population consisted of patients with moderate knee osteoarthritis (grade II-III). Therefore, the findings may not be applicable to patients with advanced or end-stage osteoarthritis.

The results of this study are consistent with recent meta-analyses that have suggested the potential of arthroscopic procedures to improve knee function and delay TKA in select patient populations (15). However, further randomized controlled trials with larger sample sizes and longer follow-up durations are necessary to validate the findings and establish AGCP as a reliable approach for joint preservation.

The findings of this study suggest that Arthroscopy-Guided Cartilage Preservation (AGCP) is a promising minimally invasive approach for improving joint function, alleviating pain, and enhancing cartilage regeneration in patients with moderate knee osteoarthritis. AGCP demonstrated superior clinical outcomes compared to conventional conservative treatment, potentially delaying the need for Total Knee Arthroplasty (TKA). However, further studies with larger sample sizes and longer follow-up durations are required to validate these results and establish AGCP as a reliable joint-preserving technique.

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