Arthroscopic surgery of the knee in local anaesthesia. An analysis of age-related pathology

Arthroscopy of the knee joint was performed in 356 consecutive outpatients in local anaesthesia and without premedication. A continuous pressure-irrigation system was used with 0.2% lidocaine chloride solution in the irrigation fluid, following administration of 5-7 ml prilocaine with epinephrine in each portal. All patients had clinical symptoms of internal derangement of the knee, such as meniscal, cruciate ligament injury or osteoarthritis. Associated intra-articular pathology was registered. Intra-articular surgery was performed in 228 cases. This included partial or subtotal meniscectomy in 207 cases and meniscus suture in 3 cases. In 18 of 228 cases (8%) the operative procedure had to be terminated due to patient discomfort. Of the meniscal injuries 84% were medial and 16% lateral. The age distribution of the medial meniscus tears was as follows: bucket handles 33 +/- 9 years; flap tears 42 +/- 10 years and degenerative tears 53 +/- 10 years. For the lateral meniscus the age distribution was: bucket handles 34 +/- 9 years, cleavage and radiating tears 37.5 +/- 12 years, flap tears 29 +/- 7 years, peripheral tears 32 +/- 9 years and degenerative tears 48 +/- 11 years. Osteoarthritis was observed in 52% of all medial degenerative tears, whereas a low frequency was found in the remaining tears. The majority of patients tolerated the procedure well. In summary, 64% of the consecutive arthroscopies were operative, including 3 meniscal sutures. Only 8% of these procedures had to be abandoned due to patient discomfort. Thus, arthroscopic surgery in local anaesthesia with no premedication is an efficient and well-tolerated method in outpatient practice.