Abstract
Objectives:
The purpose of the study was to examine the nature and frequency of complications following the most common arthroscopic knee procedures, with particular attention to fellowship training, geographic location of practice, and age and sex of the patient.
Methods:
Data were obtained from the ABOS database for orthopaedic surgeons who sat for the part II examination from 2003-2009. The database was queried to determine the type and frequency of complications for patients who underwent knee arthroscopy and for those who underwent sports medicine knee arthroscopy including arthroscopic partial meniscectomy, meniscal repair, chondroplasy, microfracture, anterior cruciate ligament reconstruction, or posterior cruciate ligament reconstruction. Factors affecting complication rates that were investigated included type of procedure, fellowship training status, geographic location of practice and age and sex of the patient.
Results:
There were 4435 complications out of 92,565 knee arthroscopic procedures obtained from the ABOS database for an overall candidate-reported complication rate of 4.8%. The complication rate was highest for PCL reconstruction (20.1%) and ACL reconstruction (9.7%). The complication rates for meniscectomy, meniscal repair, and chondroplasty were 2.8%, 7.7%, and 3.5%, respectively. The complication rate for sports fellowship trained candidates was higher than for non-sports trained candidates (5.1%: sports, 4.1%: no sports) and for male patients (4.9% vs. 4.3%). The complication rate was highest for surgeons in the Northwest (4.9%) and lowest in the South (4.2%). Younger patients (60, 3.6%). The overall rate of pulmonary embolus was 0.11%. Surgical complications were more common than medical or anesthetic complications (Table 1), and infection was the most common complication overall (0.84%).
Conclusion:
The overall self-reported complication rate for arthroscopic knee procedures was 4.7%, which may be even higher given that the data are self-reported. PCL and ACL reconstruction had the highest complication rate amongst arthroscopic procedures in this study. The increased risk of complications for sports fellowship trained surgeons may be explained by a higher percentage of complex procedures being performed by fellowship trained surgeons. Knee arthroscopy is not a benign procedure and patients should be aware of the risk of complications. In order to reduce the number of complications, surgeons should be aware of the complexity of the procedure, patient factors, and regional differences in care. Limitations of the study include self-reporting of data, which may underestimate their actual complication rate, and that surgeons in their board collection period are more likely to be earlier in their career, which may overestimate the complication rate for more experienced surgeons.