When Knee Surgery Gets Complicated

Arthroscopic knee surgery complications low but might be higher than reported

A twist of the knee in the wrong way might cause some serious damage. On the one hand, surgery to repair the knee has become more common and requires less poking around in the body. But even the most common of surgeries still comes with certain risks.

A recent study presented at a conference found that less than 5 percent of all arthroscopic knee surgeries, which involve small incisions into the knee joint, have some sort of complication.
The study also showed that procedures to repair certain ligaments in the knee resulted in the highest number of complications.
However, the number of complications in total might actually be higher than reported, according to the researchers of this study. 

"Ask your surgeon about the risks of knee surgery."

A team of researchers led by Matthew J. Salzler, MD, from the University of Pittsburgh Medical Center, tracked the frequency and nature of complications following the most common arthroscopic knee procedures.
These researchers gathered data from the American Board of Orthopaedic Surgery (ABOS) database for fellow orthopedic surgeons in training between 2003 and 2009.
From the database information, the researchers tracked the type of complications that occurred and how often they happened.
Complications were grouped into one of three categories based on what caused them. These categories consisted of surgical, medical and anesthetic complications. This means that the complications resulted from the surgery itself, the quality of medical care or the anesthesia used to numb patients during surgery.
The age and gender of the patients was also noted, as well as the training doctors underwent and the location of their practice.
Some of the patients underwent sports medicine knee arthroscopy, which is a common surgical procedure that allows a doctor to view the inside of the knee with a small camera inserted into the knee joint through small incisions.
Within this branch of surgery, the researchers focused specifically on six different types of surgery.
Two of the surgery types included arthroscopic partial meniscectomy and microfracture procedures, which repair torn cartilage and damaged bone in the knee. Another surgery, called meniscal repair, targets the rubbery, C-shaped cartilage discs that cushion the knee.
Other surgery procedures included chondroplasty, which reshapes the knee joint, as well as anterior cruciate ligament (ACL) reconstruction and posterior cruciate ligament (PCL) reconstruction. These reconstructive surgeries repair the respective ligaments inside the knee joint.
Out of more than 92,500 knee arthroscopic procedures, the researchers found that 4,435 complications occurred. This accounted for 4.7 percent of all procedures.
The number of complications was greatest among those who had PCL reconstruction. The researchers found that 20.1 percent of patients who had PCL reconstruction had some sort of complication.
ACL reconstruction followed with 9.7 percent of patients reporting some complication.
Complications from the surgery itself were more common than medical or anesthetic complications. Among surgeries, 3.68 percent had surgical complications while medical and anesthetic complications were present in 0.77 and 0.22 percent of surgeries, respectively.
When comparing patients' gender, 4.9 percent of male patients versus 4.3 percent of female patients had some complication.
The number of complications was higher among surgeons in the Northwest than in the South. Complications occurred among 4.9 percent of surgeons in the Northwest and 4.2 percent of surgeons in the South.
Procedures done by sport fellowship-trained candidates also had a higher number of complications than procedures done among general (non-fellowship trained) orthopedic surgeons.
Specifically, 5.1 percent of sports-trained surgeons and 4.1 percent of non-sports trained surgeons performed procedures that resulted in 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," the researchers wrote in their report.
The researchers noted a few limitations of their study, including that their data was reported by the patients themselves, which might have led to an underestimation of the actual number of complications.
In addition, the surgeons included in the data collection were likely to be earlier in their career, which might have led to an overestimation of the number of complications that occurred among more experienced surgeons.
This study was presented at the American Orthopaedic Society for Sports Medicine Annual Meeting in Chicago from July 11-14. The findings are still in the preliminary stages and have not been published in a peer-reviewed journal.
Review Date: 
July 18, 2013