An IA Saucerization of the knee is an advanced arthroscopy procedure that removes bone spurs and excess fat from the knee to eliminate pain and abnormal function of the knee joint while walking. A collection of bone and bone marrow, not a simple bone marrow aspiration, collected through a stab incision at the hip is converted into a bone graft slurry and then injected into the bone at the site of the excess fat, thus restoring the bone's health. The procedure also smooths over the cartilage and repairs the menisci and ensures their proper function. The surgeon must use unique entry portals into the knee; thus, the procedure requires the use of specialized arthroscopes and products designed by Orthopedic Sciences. The patient can go home on the day of surgery, and no incision is larger than 3mm. See our Patient Stories and note that our products have been used for over 20 years. 

The more popularly known knee arthroscopy for osteoarthritis with a meniscus tear does not thoroughly clean and reshape the knee bones to as near normal as possible, nor does the procedure aim to ensure proper meniscus function. Currently available arthroscopic equipment is NOT designed to achieve this objective. Further, orthopaedic surgeons performing arthroscopy for osteoarthritis with a meniscus tear do not do so with an understanding of how fat under pressure within the bone causes the osteophytes to form. See Figures 9A and 9B on our Knee FAQs page. Explore our web pages and carefully read through the information presented. Search the internet for information on saturated and trans fats and how they affect the health of your bones, watch our patient testimonials, be engaged with your healthcare, share our website (www.orthopedicsciences.com) with your doctor to ask the pertinent questions, and join our efforts to help you keep the joint you were born with. 

The procedure also recontours the cartilage where it is torn and ensures proper function of the meniscus during walking by cleaning or repairing the meniscus and removing any osteophytes that block the meniscus from gliding backward and forward while walking. The function of the meniscus is assessed while in surgery, and it is never assumed that the primary problem with the meniscus is the tear observed on a preoperative MRI.

Osteophytes form when excess fat attempts to escape the bone. These osteophytes are easily seen on x-ray and have a characteristic shape resulting from knee motion. During an IA Saucerization, the surgeon also decompresses the thigh bone by releasing this excess fat from the bone using percutaneous intraosseous irrigation. Cancellous bone and bone marrow are taken from the hip above the knee and then injected into the bone to replace the excess fat. The cancellous bone and bone marrow injected into the bone improve the bone’s health and strength. An IA Saucerization should not be performed using traditional arthroscopes.¹ Traditional arthroscopes lack the properties of OSI’s Q Arthroscopes designed to save joints. The skilled surgeon performs the IA Saucerization through two to three small incisions while repeatedly motioning the knee as if the patient were walking. Fluoroscopy should be used during surgery as well. On the morning of surgery, the patient is asked to mark the most painful areas of the knee. This helps the surgeon focus immediately on the most painful parts of the knee during surgery. The blood pressure and heart rate are monitored for abrupt changes indicating that the areas being cleaned/reshaped contribute to the pain experienced by the patient. These painful areas are matched to the ink markings placed on the skin by the patient. The surgeon correlates the arthroscopic findings with the patient’s history, physical examination, x-rays, and MRI and ensures that the anatomy of the knee is restored to as near normal as possible and that the menisci are moving backward and forward smoothly after their cleaning or repair. The surgery can be performed with or without a tourniquet.

Additionally, OSI’s specialized bone grafting system for joint preservation allows the surgeon to collect autologous cancellous bone and bone marrow through a two to three mm incision at the hip. Your doctor may require you to use crutches for two to four weeks after surgery, and home exercises may be equally as effective as outpatient physical therapy. A continuous passive motion machine (CPM) or any other apparatus is usually not required. Given the very small incisions, significant scarring after surgery is unlikely. Most patients can go home the day of surgery.

The following steps comprise an IA Saucerization of the knee:

1. The treating surgeon has determined that the patient is a good candidate for the procedure. The physician is committed to performing all essential steps and using the proper equipment. Attempting the procedure with “routine equipment” because the surgeon is a skilled arthroscopist and thinks that an IA Saucerization is nothing more than “arthroscopy and a meniscus tear with a different name” is not advised. An IA Saucerization is more extensive arthroscopy and the proper equipment must be used. Additionally, using the proper equipment but not committing to the full procedure is not recommended. The surgeon must understand and acknowledge the underlying issues causing pain, osteophyte formation, and meniscus pathology. The overall alignment of the knee must be considered as well.
2. On the morning of surgery, the surgeon marks the affected knee.
3. The patient uses the marker to identify the areas causing the most pain.  The surgeon may ask the patient to be specific and avoid drawing large circles as areas of global pain or commenting, “the whole knee hurts.” The patient must be engaged.
4. While in surgery, spongy bone and bone marrow are obtained from the hip through a 2 mm incision. The surgeon uses the OSI Bone Saver to auto concentrate this bone graft and bone marrow (biomass). The collected biomass is placed on the back table in anticipation of its later use. “Spinning down” of the graft and bone marrow is unnecessary. OSI’s system auto concentrates the biomass.
5. After collecting the biomass, the surgeon uses OSI’s Q Arthroscope and Clear Cannula to enter the knee joint through portals at the top of the knee, allowing an IA Saucerization to be performed safely and effectively. A tourniquet may not be required. Conventional apparatuses for knee arthroscopy are NOT required, and only a single scrub technician is needed.
6. The surgeon explores the knee while the scrub technician takes the knee through its range of motion. The surgeon depresses the areas marked by the patient and matches these locations with the findings inside the knee. The menisci are identified, and the surgeon determines the presence of a tear and if osteophytes are blocking their motion. The surgeon contemplates that if the meniscus is trapped by an osteophyte or cartilage flap, was such trapping identified on the preoperative MRI? The surgeon considers that normal knee motion causes constant stretching of a blocked meniscus, which may cause the tear of the meniscus that led to the surgery being performed in the first cause. This constant stretching may lead to a meniscus root tear as well. Are the osteophytes and cartilage flaps shredding the menisci, causing a so-called degenerative tear? The debridement begins, and a repair of the meniscus is performed as needed. Is the meniscus now moving freely after removing the blocking osteophyte and cartilage?
7. Fluoroscopy is brought over the knee, if necessary, to ensure that the obvious osteophytes seen on x-ray are removed. Before surgery, It is helpful to determine if osteophytes are impairing the overall motion of the knee, the menisci and causing pain.
8. The surgeon remains aware of changes in the patient’s heart rate, and blood pressure as the painful areas marked by the patient are debrided. The anesthesiologist or CRNA provides this hemodynamic (heart rate and blood pressure) feedback, and often after the diseased area has been debrided, the heart rate and blood pressure no longer change. The surgeon observes the excess fat entering the joint through the debrided osteophytes and is assured the excess fat is being removed as the arthroscope irrigates the joint while the debridement tools remove the excess fat and debris.
9. The surgeon now uses fluoroscopy to percutaneously (through the skin) insert OSI’s Beacon Biomass Delivery Trephine into the bone. The surgeon directs this small 3 mm trephine toward the area of excess fat, osteopenia, bone marrow edema, or osteophyte formation. This patented tool allows the surgeon to irrigate the inside of the bone to remove excess fat, oxLDL (Bad Cholesterol), and proteins that cause inflammation, pain, and cartilage destruction. OSI’s system does NOT simply move the fat and cholesterol out of the way by pushing them into circulation. This would be the case when one attempts to inject a bone marrow concentrate without first irrigating the bone. The oxLDL  and pro-inflammatory proteins are removed from the bone through OSI’s patented technology, the Beacon Biomass Delivery Trephine. The surgeon recognizes that the patient is NOT only irrigating the inside of the joint but also irrigating the diseased areas inside of the bone, truly advancing arthroscopy for osteoarthritis with a meniscus tear. This part of the procedure is called an Irrigation Osteoplasty vs. a simple osteoplasty or other commercially recognized names. A basic osteoplasty attempts to inject spun down bone marrow, or perhaps PRP, combined with an off-the-shelf bone graft substitute without first ensuring the host bed (the site where the bone graft and bone marrow are injected) is ideal for new bone formation. The Irrigation Osteoplasty ensures the host bed is ideally suited for new bone formation.
10. With the Beacon Biomass Delivery Trephine, BBDT, in its optimal position, the biomass is delivered to the bone. The BBDT need not be removed from the position obtained for irrigating the diseased area of bone. Simply remove the irrigation needle and begin the grafting process. OSI’s system does NOT require excessive pressure to deliver the biomass. Excessive pressure is characteristic of competitive systems designed to deliver a biomaterial to a diseased area of bone.
11. The surgeon uses the Q Arthroscope to observe additional excess fat exit the bone, further ensuring its removal.
12. All incisions are closed with a single stitch.