Editorial Commentary: Obesity and Osteoarthritis Are Risk Factors for Conversion to Arthroplasty, With or Without Previous Knee Arthroscopic Surgery.

Arthroscopic surgeries serve a variety of different functions within the knee. Some procedures, like meniscectomies and chondroplasties, can improve patient function and pain but do not restore joint biomechanics, whereas meniscus repair and ligament reconstructions attempt to restore native knee biomechanics and contact pressures. It is well known that the same risk factors for poor clinical and patient-reported outcomes for arthroscopic surgeries, like osteoarthritis and obesity, lead to knee arthroplasty, and the intra-articular pathologies that lead to arthroscopic procedures also generally lead to increased rates of arthroplasty. What is unclear is how factors relating to an original injury (such as associated subchondral edema) versus the surgery itself, the timing of surgery, or patient factors (such as obesity and pre-existing osteoarthritis) contribute to progression to arthroplasty. What we do understand is there is an increasing drive to perform arthroscopic procedures that seek to restore native knee biomechanics and tissue function, such as meniscus repair or ligament reconstruction, because it is well established that arthroscopy has a limited role in patients with degenerative joint disease absent specific mechanical symptoms.