Complications in arthroscopic surgery performed by experienced arthroscopists

Twenty-one experienced arthroscopists participated in a prospective, 19-month study to analyze complications in arthroscopic surgery of the knee and other joints. Participants responded to a monthly questionnaire that provided information on a case-by-case basis for the duration of the study. A total of 63 specific procedures were studied. A total of 10,262 procedures were recorded. Procedures performed on the knee joint were most prevalent in the study (8,741 or 86%). Complications were placed in one of 11 descriptive categories for analysis; 173 complications occurred and the overall complication rate was 1.68%. The types of complications recorded in order of frequency were hemarthrosis, 60.1%; infection, 12.1%; thromboembolic disease, 6.9%; anesthetic complications, 6.4%; instrument failure, 2.9%; reflex sympathetic dystrophy, 2.3%; ligament injury, 1.2%; and fracture and neurologic injuries, 0.6% each. The remainder were miscellaneous complications, 6.9%. No vascular injuries were reported. The two most frequent procedures reported were medial meniscectomy (2,468) with a complication rate of 1.78%, and lateral meniscectomy (1,149) with a complication rate of 1.48%. Overall, there was a lower incidence of complications in meniscal repair (1.29%), including both inside-out and outside-in techniques, than in meniscectomy (1.69%). In-depth information was gathered on each complication. In addition, profiles on surgical techniques and surgical equipment were obtained from each of the contributing surgeons. The complication rate in arthroscopic surgery was found to be higher than had been previously found in retrospective surveys. With further analysis oft he complication data and profiles of the surgeons, protective techniques can be further identified to help reduce the incidence of complications in arthroscopic surgery.