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The Journal of Bone and Joint Surgery, Vol 68, Issue 2 256-265, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases
OH Sherman, JM Fox, SJ Snyder, W Del Pizzo, MJ Friedman, RD Ferkel and MJ Lawley
In a retrospective review of 3,261 arthroscopic procedures on the knee,
2,640 met the criteria for inclusion in this analysis. The patients' ages
ranged from eight to eighty-three years. There were 1,541 male and 1,099
female patients. Eight hundred and ninety-five of the injuries were
work-related. A tourniquet was used in 1,175 procedures and the average
tourniquet time was thirty minutes. There were 216 complications over-all
(8.2 per cent), 126 being designated as major and ninety-seven, as minor.
The major complications that were evaluated were infections, hemarthrosis,
adhesions, effusions, cardiovascular, neurological, reflex sympathetic
dystrophy, and instrument breakage, and the minor complications were
difficulties with wound-healing and ecchymosis. Chi-square analysis showed
the following factors to be significant (p less than 0.05). Patients with
an industrial injury had a higher rate of neurological complications and
reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest
over-all complication rate. Partial medical meniscectomy was associated
with a higher over-all complication rate and the highest hemarthrosis rate,
and partial lateral meniscectomy was associated with the highest rate of
instrument breakage. Abrasion arthroplasty had the highest rate of
complications of wound-healing, and subcutaneous lateral release was
associated with the most adhesions. The sex of the patient and whether or
not a tourniquet had been used had no effect on complications. The
experience of the surgeon with arthroscopic procedures also had no
correlation with the complication rate. Multiple regression analysis showed
that two factors (age and, if a tourniquet was used, the tourniquet time)
were dominant predictors of complications. From these data, a model was
devised for predicting which patients were at risk for complications and
their relative levels of risk. Certain complications may be preventable,
and for others the risk factors can be reduced. The high-risk patients in
our series were fifty years old or older and had a tourniquet time of sixty
minutes or longer.
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