“Knee arthroscopy is often thought of as a benign procedure, but patients should be aware of the risk of complications,” presenter Matthew J. Salzler, MD, told members of the American Orthopaedic Society for Sports Medicine (AOSSM) during their 2013 annual meeting last month. Based on the results of a study conducted by Dr. Salzler and colleagues at the University of Pittsburgh, arthroscopic posterior cruciate ligament (PCL) reconstruction had a complication rate that was more than double that for arthroscopic anterior cruciate ligament (ACL) reconstruction.

The researchers examined the nature and frequency of complications following the most common arthroscopic knee procedures, with particular attention to fellowship training status, geographic location of practice, and age and sex of the patient.

Data were obtained from the American Board of Orthopaedic Surgeons (ABOS) database for orthopaedic surgeons who sat for the part II examination from 2003 through 2009. Researchers queried the database to determine the type and frequency of complications for patients who underwent knee arthroscopy and for those who underwent sports medicine knee arthroscopy including the following:

• arthroscopic partial meniscectomy
• meniscal repair
• chondroplasty
• microfracture
• ACL reconstruction
• PCL reconstruction

Complication rates
Based on the ABOS database, researchers identified 4,435 complications out of 92,565 knee arthroscopic procedures, for an overall candidate-reported complication rate of 4.8 percent. Surgical complications were more common than medical or anesthetic complications (Table 1).

Complication rates for specific procedures were as follows:

• arthroscopic partial meniscectomy—2.8 percent
• meniscal repair—7.7 percent
• chondroplasty—3.5 percent
• ACL reconstruction—9.7 percent
• PCL reconstruction—20.1 percent

Candidates who had completed a sports fellowship had a higher complication rate (5.1 percent) than those who did not have a sports fellowship (4.1 percent). “The increased risk of complications for sports fellowship-trained surgeons may be due to the fact that they perform a higher percentage of complex procedures,” explained Dr. Salzler.

Male patients had a higher complication rate (4.9 percent) than female patients (4.3 percent).

Researchers also found variations in complication rates based on practice location. Surgeons in the Northwest had the highest complication rate (4.9 percent), while surgeons in the South had the lowest rate (4.2 percent).

In examining specific types of complications, the researchers found that infection was the most common complication overall, accounting for 0.84 percent of all complications. The overall rate of pulmonary embolus was 0.11 percent.

Self-reported data
Dr. Salzler noted two limitations to the study. Because the data were self-reported, the actual complication rate may be higher. And because the surgeons were in their board collection period, and thus more likely to be earlier in their career, the complication rate for more experienced surgeons may be lower.

“To reduce the number of complications, surgeons should be aware of the complexity of the procedure, patient factors, and regional differences in care,” concluded Dr. Salzler.

Dr. Salzler’s coauthors for “Complications Following Arthroscopic Knee Surgery” include Chealon Dain Miller, MD; Albert Lin, MD; Sara Herold, MS; James J. Irrgang, PhD, PT, ATC; and Christopher D. Harner, MD.

Disclosure information: Drs. Salzler and Lin, Ms. Herold—no conflicts. Dr. Miller—VIVUS. Dr. Irrgang—Orthopaedic Section of the American Physical Therapy Association. Dr. Harner—CONMED; Linvatec; Smith & Nephew; Wolters Kluwer Health - Lippincott Williams & Wilkins; American Orthopaedic Association; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine.

Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at porucznik@aaos.org

Bottom Line

• Although often seen as a benign procedure, arthroscopic knee surgery may have complications that surgeons should discuss with patients.
• This database review study found that arthroscopic procedures had complication rates ranging from 2.8 percent to more than 20 percent.
• Arthroscopic PCL reconstruction had the highest complication rate, and infection was the most common complication.