| Backgroud :Osteoarthritis is the most prevalent joint disease in older and is characterized by deterioration and loss of articular carticu- lar,subchondral sclerosis and osteophyte formation.It is also a common problem encountered by orthopedic surgeons.Although sev- eral options are available for treatment of osteoarthritis symptoms —simple analgesics,nonsteroidal anti-inflammatory drugs,intraarti- cular injection of glucocorticoids—no medical intervention has been shown to halt disease progression or reverse joint damage in humans.Recently,arthroscopic debridement and intra-articular sodium hyaluronate(hyalgan) injection are utilized for the treatment of knee osteoarthritis widespreadly in our country.Both of them have been shown to improve symptoms for up to 1 year in some literatures,but the multiple methodological flaws of their study cast doubt on the usefulness of their findings.Clinical variables were only partially helpful for predicting a successful result after therapy,and a search for other biologic markers (such as synovial fluid and serum)may be benefit. Objective: The aim of the study is to estimate the effectiveness of arthroscopic debridement and intra-articular sodium hyaluronate (hyalgan) injection for patients suffering from knee osteoarthritis ; to determine if they are possible to decrease pain, increase range of motions and mobility function;to explore their influences on the level of interleukin-1(IL-1) and nitric oxide(NO) in serum and synovial fluid;and to compare the symptomatic relief (in terms of the Lysholm scales)produced by hyalgan and arthroscopic debridement when used for knee osteoarthritis.Material and Methods: The subjects of the study were patients with grade I to grade III with knee osteoarthritis (Kellgren-Lawrence classification),who were randomized to receive either arthroscopic debridement or intra-articular sodium hyaluronate(hyalgan) injection at our hospital and the NO.1 Hospital of Jilin University in January/2001 to March/2003. Sixty nine patients(eighty one knees) were examined by questionnaire:32 case(41 knees) was the group of arthroscopic surgery(AS);37 case(48 knees) was the group of sodium hyalgan injection(SH).Fllow-up was 1 years. All of the cases were estimated by Lysholm scoring scale pre-intervetion and 1 year post-intervetion,and then some cases were collected serum and synovial fluid in which the level of IL-1 and NO were detected before and after therapy,respectively through Nitrate reductase and enzyme-linked immuneoabsordent assay(ELISA).In our study,SPSS 10.0 was utilized for statistical analysisResults: Lysholm scores of the two groups were greatly improved:in the AS group, 46.0(SE1.9) pre-op and 81.5(SE1.7) one year post-op;in the SH group, 46.4(SE1.9) pre-op and 75.7(SE1.6) one year post-op. There were significant differences between the two treatment groups for scores one year post-op,and the rate of satisfaction one year post-op in AS group was 73.2% superior to 58.3% in SH group.In addition,before therapy,levels of IL-1 and NO in synovial fluid were obviously higher than them in blood serum of knee osteoarthritis patients.There were significant differences betwe- en pre-op and post-op for levels of IL-1 and NO in serum and synovial fluid,however,there were no significant differences between the two groups.Conclusions:The results indicate that both arthroscopic debridement and sodium hyalgan injection produce statistically and clinically significant improvement of symptoms in patients with mild to moderate knee osteoarthritis, in addition,both of them can down- regulate levels of IL-1 and NO in serum and synovial fluid of patients.In this study,we discovered that the results were better in the arthroscopic group in terms of Lysholm scoring scale,and this reached statistical significance.Both arthroscopic debridement and intra-articular sodium hyalgan injection are effective and valuable treatments for patients with knee osteoarthritis who have ongoing pain or are unable to tolerate joint replacement. Arthr...
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