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Background: Despite the fact that previous research has indicated that giving prophylactic antibiotics to patients having normal knee arthroscopy may not be necessary and may, in fact, cause more problems than it solves, it is yet usual practice to do so. The objective of this study is to assess the incidence of surgical site infections in patients who have routine knee arthroscopy without the use of antibiotics as a prophylactic strategy in order to determine the frequency of such infections. Methods: This is an analysis of 250 consecutive patients who had regular knee arthroscopy done on them between the Jan 2020 to Dec 2021 at a single institution by a single fellowship-trained sports surgeon. The assessment was carried out by one researcher. The operation was performed on each of the patients at precisely the same time. Patients had a large number of different surgical techniques, including arthroscopic meniscectomy, meniscal repair, microfracture, chondroplasty, removal of loose bodies, and lateral retinacular release. Antibiotics were not administered to any of the patients as a prophylactic measure. The postoperative care of each and every patient was monitored for a period of at least two years, and the patients' demographic information as well as their list of ailments were evaluated. After the surgery, every issue that surfaced was documented in detail. Results: The findings revealed that there were a total of 154 male and 96 female patients. The standard deviation was 11, and the mean operating duration was 31 minutes. The mean age was 42.1 years. Two young patients who were otherwise healthy developed a postoperative superficial wound infection within a week after their surgery, but they made a full recovery after receiving oral antibiotic therapy in the outpatient setting. The incidence of infection was 0.36 percent across the board. There were no reports of any instances of severe infection. This research found an extremely low risk of surgical site infections, which is equivalent to rates that are already known to occur after these types of surgeries. This indicates that preventive antibiotics are not required, which allows one to avoid the hazards that are often linked with their use., http://impactfactor.org/PDF/IJTPR/12/IJTPR,Vol12,Issue12,Article26.pdf

OBJECTIVE: To determine the proportions of patients who (1) perceived their symptoms to be satisfactory, (2) perceived their treatment to have failed, or (3) perceived that they improved to an important degree at 3 months after arthroscopic meniscal surgery; and to determine Knee injury and Osteoarthritis Outcome Score (KOOS) subscale scores corresponding to the Patient Acceptable Symptom State (PASS), treatment failure, and the minimal important change (MIC) for improvement.DESIGN: Prospective cohort study.METHODS: Patients from the Knee Arthroscopy Cohort Southern Denmark who had arthroscopic meniscal surgery were included. The PASS, treatment failure, and MIC improvement values were calculated for the KOOS subscales with anchor-based approaches, using the adjusted predictive modeling method. Subgroup analyses were performed by stratifying by age (40 years or younger versus older than 40 years) and surgery type.RESULTS: Six hundred fourteen patients (44% female; mean ± SD age, 50 ± 13 years) were included. At 3 months after arthroscopic meniscal surgery, 45% of patients perceived their symptoms to be satisfactory, 19% perceived the treatment to have failed, and 44% to 60% perceived that they had improved to an important degree across the 5 KOOS subscales (for PASS/treatment failure, respectively: pain, 74 and 60 points; symptoms, 72 and 61 points; function in activities of daily living, 81 and 68 points; sport and recreational function, 43 and 26 points; and knee-related quality of life, 52 and 40 points; for MIC improvement: pain, 12 points; symptoms, 8 points; function in activities of daily living, 12 points; sport and recreational function, 17 points; and knee-related quality of life, 9 points). The PASS values were 6 to 17 points higher for patients 40 years or younger compared to patients older than 40 years.CONCLUSION: At 3 months after meniscal surgery, approximately half of the patients perceived their symptoms to have improved to an important degree, 4 in every 10 patients perceived their symptoms to be satisfactory, and 2 in every 10 patients perceived the treatment to have failed. J Orthop Sports Phys Ther 2021;51(6):281-288. Epub 30 Jan 2021. doi:10.2519/jospt.2021.10149.

Prior research has demonstrated that physician desire to optimize patient satisfaction is a cause of over-prescription of opioid medications in the healthcare setting. The purpose of this study was to investigate what effect, if any, decreased opioid prescribing following arthroscopic meniscectomy had on Press-Ganey (PG) satisfaction survey scores.A retrospective review of prospectively-collected data was conducted on patients who underwent arthroscopic meniscectomy between October2014-October2019. Inclusion criteria consisted of complete PG information, no history of trauma, connective tissue disease, or prior knee surgery. Groups were separated based on date of surgery relative to implementation of an institutional opioid reduction policy which occurred on October 1, 2018. Prescriptions were converted to milligram-morphine-equivalents (MME) for direct comparison between opioids. Minimal-Detectable-Change (MDC) was calculated to evaluate clinical significance of any statistically significant findings.554 patients were included in this analysis (452pre-protocol, 102post-protocol). The groups did not differ statistically (p 0.05) with respect to any patient demographics (age, BMI, sex, prior opioid use, opioid naivete) with the exception of smoking history; 54.4% in the pre-protocol group and 32.4%in the post-protocol group; p 0.001. Mean discharge dose for the pre-protocol group was 229.3 ± 141MME, and 80.05 ± 82.7MME post-protocol; P 0.0001. There were no statistically significant differences between pre-and-post-protocol satisfaction with pain control scores; P = 0.15. The differences between satisfaction with pain control did not meet clinical or statistical significance, based on a calculated MDC = 0.368. Among pre-protocol patients, 372(82.3%) gave a "top box" response to the question "degree-to-which-your-pain-was-controlled", compared to 91(89.2%) from the post-protocol group; P = 0.10.A reduction in opioids prescribed after arthroscopic meniscectomy was not associated with any difference in patient satisfaction with pain management, as measured by the Press-Ganey survey. LOE: 3.

Highlights • It is the first report about severely abnormal respiratory symptoms in a young patient following ambulatory surgery. • The patients in Ambulatory Surgery Center are in good condition, it’s easy to neglect the importance of preoperative preparation. • More extensive clinical and psychological examinations prior to surgery are necessary in young individuals in the Ambulatory Surgery Center., Introduction Ambulatory surgery has the advantages of shortening the waiting time for hospitalization and reducing medical expenses. It has been more and more widely used in recent years in China. The patients admitted in Ambulatory Surgery Center are generally in good condition (ASA I-II), with clear diagnosis, short operation time, low operation risk and low incidence of postoperative complications. It is easy to paralyze the medical staff, neglecting the importance of preoperative preparation, and then causing physical and psychological damage to the patient. Presentation of case We describe the case of a 21-year-old woman, presented with erratic respiratory rate with a maximum of 40 breaths min−1 and a minimum of 7 breaths min−1 after undergoing arthroscopic meniscectomy. The arterial blood gas analysis revealed a disruption of the acid-base homeostasis with respiratory alkalosis and metabolic acidosis, while all other examinations were normal. Discussion Drug-related adverse reactions, emergence agitation or psychiatric factors may have caused the observed symptoms. Conclusion Our observations demonstrate that more extensive clinical and psychological examinations prior to surgery involving general anesthesia may help in avoiding anesthesia-related complications, even in young individuals from the Ambulatory Surgery Center.

Arthroscopic knee surgery to perform partial meniscectomy and anterior cruciate ligament (ACL) reconstruction is frequent and effective, although a possible complication is postoperative hemarthrosis. When intraarticular bleeding occurs, in addition to the associated pain, the patient usually requires joint aspiration (arthrocentesis) to avoid loss of range of motion (ROM). Sometimes this complication ends up associated with a poor result of surgery due to a loss of ROM. The aim of this narrative review of the literature is to attempt to clarify whether tranexamic acid (TXA) should be utilized in arthroscopic ACL reconstruction and arthroscopic meniscectomy and by what route (intraarticular or intravenous). A number of studies seem to favor the use of intravenous TXA in patients undergoing ACL reconstruction and arthroscopic synovectomy to diminish articular postoperative bleeding and its consequences (pain, swelling, loss of ROM, and the need for arthrocentesis). Regarding the use of intraarticular TXA, one in-vitro study has indicated that TXA in high concentrations is cytotoxic to chondrocytes. Common sense leads me to conclude that until better designed studies can confirm that intraarticular TXA is not cytotoxic to chondrocytes, its use should not be advised. Currently, for patients undergoing arthroscopic ACL reconstruction and arthroscopic meniscectomy, it seems safer to use intravenous TXA.

Background Post-arthroscopic osteonecrosis of the knee (PAONK) is a rare condition. No studies have analyzed the relationship between the meniscus extrusion and PAONK. The purpose of this retrospective study is to test a hypothesis that the degree of the medial meniscus (MM) extrusion might be significantly greater in the knees with PAONK than in the matched control knees both before and after the meniscectomy. Methods Ten knees with PAONK were detected out of a total of 876 knees which had undergone arthroscopic partial meniscectomy of the MM. Ten matched control knees were randomly selected out of the remaining 866 knees without PAONK. The clinical data of these 20 patients were retrospectively collected from the medical records. To evaluate the location of the menisci on the joint line, Extrusion width and Inner width were defined on a coronal section of magnetic resonance imaging (MRI). The intra- and inter-rater reliability was evaluated by calculating the intra- and inter-class coefficients. Statistical comparisons between the 2 groups were made using the 3 non-parametric tests. Results Before the meniscectomy, the Extrusion width of the MM (mean 4.7 ± 1.4 mm) was significantly greater than that (3.0 ± 1.3 mm) in the Control group (P = 0.0195). In the MRI taken in a range from 3 to 50 weeks after the meniscectomy, the Extrusion width of the MM (5.9 ± 1.1 mm) in the PAONK group was significantly greater than that (3.4 ± 1.4 mm) in the Control group (P = 0.0009), and the Inner width of the MM (0.6 ± 1.7 mm) in the PAONK group was significantly less than that (3.9 ± 1.0 mm) in the Control group (P = 0.0001). Conclusion A significant relationship was found between the degree of the MM extrusion and the onset of PAONK. This study suggested that the extrusion of the MM is a potential predisposing factor for PAONK.

(1) Background: The medial meniscus horizontal tear (MMHT) is known as a lesion that can be treated nonoperatively. However, some patients show persistent pain despite conservative treatments. In arthroscopic surgery for MMHT, surgeons often encounter unexpected unstable flaps, which can explain the intractable pain. This study aimed to determine whether preoperative factors could predict the hidden unstable flaps in MMHT. (2) Materials and Methods: Medical records of 65 patients who underwent arthroscopic partial meniscectomy (APM) for isolated MMHT during 2016–2020 were retrospectively reviewed. APM was indicated when there was no severe chondral degeneration and intractable localized knee pain in the medial compartment did not resolve despite conservative treatments. Unstable flap was confirmed based on arthroscopic images and operation notes. Each of the following preoperative factors were investigated using logistic regression analyses to determine whether they can predict an unstable flap: age, sex, body mass index, lower limb alignment, trauma history, mechanical symptoms, symptom duration, visual analogue scale (VAS), Lysholm score, cartilage wear of the medial compartment, and subchondral bone marrow lesion (BML). (3) Results: Hidden unstable flaps were noted in 45 (69.2%) patients. Based on univariate analyses for each preoperative factor, age, symptom duration, cartilage wear (of the femoral condyle and the tibial plateau), and subchondral BML were included in the multivariate logistic regression analysis. The results showed that symptom duration (p = 0.026, odds ratio = 0.99) and high-grade cartilage wear of the medial femoral condyle (p = 0.017, odds ratio = 0.06) were negatively associated with unstable flaps. A receiver operating characteristic curve was used to calculate the symptom duration at which the prediction of unstable flaps was maximized, and the cutoff point was 14.0 months. (4) Conclusions: More than two thirds of patients suffering intractable pain from MMHT had hidden unstable flaps. However, APM should not be considered when the symptom duration is more than 14 months or high-grade cartilage wear of the medial femoral condyle is noted.

Introduction Deep vein thrombosis (DVT) following arthroscopic surgery is a rare condition, especially arthroscopic meniscal surgery. There have been three reported cases of DVT after arthroscopic meniscal procedure, all related to arthroscopic meniscectomy. In this study, we reported the first case of symptomatic DVT at the level of the femoral vein to the popliteal vein following arthroscopic meniscal root repair. Case presentation The case was a 55-year-old Thai female who presented with left knee pain for 2 months after a fall. She was diagnosed as left medial meniscal root injury and had had an arthroscopic meniscal root repair. At 6 weeks post-operatively, she developed left leg swelling without pain. She was diagnosed as DVT and was initially treated with enoxaparin for three days then warfarin for three months. Conclusion We report a case of symptomatic DVT that extended from the femoral vein to the popliteal vein after arthroscopic meniscal root repair. The risks of DVT following arthroscopic surgery are aged more than 40 years old and tourniquet time more than 60 min., Highlights • Symptomatic DVT can develop after arthroscopic meniscal root repair. • Patients undergoing arthroscopic knee surgery should be advised to watch for signs of DVT. • If the patient develops leg swelling after arthroscopic surgery, they should see their doctor immediately.

In 2008, the French National Authority for Health (HAS) recommended that "conservative" treatments be adopted for meniscal lesions. This recommendation and the lack of superiority of meniscectomy over non-operative treatment for meniscus degeneration have modified the treatment pathway. However, the impact of these findings on French clinical practice is not known. The objective of this study was to evaluate the change over time in the number of alternative surgical procedures (meniscectomy and meniscus repair) and regional variation in France using data from the French agency for information on hospital care (ATIH).We hypothesized that the number of meniscectomy procedures will decrease, and the number of repair procedures will increase over time at various healthcare facilities.Between 2005 and 2017, the number of hospitalizations in the Medicine-Surgery-Obstetrics wards for meniscectomy (NFFC003 and NFCC004) or meniscus repair (NFEC001 and NFEC002) was evaluated overall and then based on whether the stay occurred in public or private sector hospitals in France. Data were extracted from the ATIH database and the findings were (1) related to French demographics during the period in question; (2) separated into public or private sector hospitals; (3) distributed into various regions in France and; (4) stratified by patient age.Between 2005 and 2017, 1,564,461 meniscectomy and 63,142 meniscus repair procedures were done in France. Over this period in the entire country, the meniscectomy rate gradually decreased from 19.80/10,000 inhabitants in 2005 to 15.77/10,000 inhabitants in 2017 (21.4% reduction) (p0.0001) while the meniscus repair rate increased from 0.42/10,000 inhabitants in 2005 to 1.36/10,000 inhabitants in 2017 (320% increase) (p0.0001). The largest meniscectomy reduction effort occurred in private sector hospitals, going from 15.79 to 12.01/10,000 inhabitants in 12 years; the decrease was smaller in public hospitals (going from 4.01 to 3.77/10,000 inhabitants) (p0.0001 in both cases). The change in the procedure ratio between private and public hospitals was asymmetric, with the meniscus repair/meniscectomy ratio clearly increasing more in public hospitals (4% to 12.6%) between 2005 and 2017 than in private hospitals (1.6% to 6.6%) (p0.0001). We found large regional differences: regions in Eastern France had higher meniscectomy rates, while regions in Western France had higher meniscus repair rates. When the analysis of procedures between 2008 and 2017 was stratified by age, a similar increase in repair procedures was found in all age brackets. Conversely, the reduction in meniscectomy was most apparent before 40 years of age, and the number of meniscectomy procedures was stable after 60 years of age.These findings suggest there has been a significant shift in the surgical management of meniscal injuries towards more conservative treatments. But the large variations between regions in France is evidence of a continued disparity in clinical practices.IV, retrospective study without control group.

Background: Arthroscopic meniscectomy has been commonly performed for persistent pain caused by degenerative medial meniscal posterior root tears (MMPRTs). However, risk factors that affect long-term outcomes and joint survivorship after meniscectomy are unclear. Purpose: To identify the risk factors associated with end-stage osteoarthritis after arthroscopic meniscectomy for degenerative MMPRT for middle-aged or elderly patients and to determine the joint survivorship according to the identified risk factors. Study Design: Case-control study; Level of evidence, 3. Methods: Data from 288 patients (24 male and 264 female), followed for at least 5 years after arthroscopic meniscectomy for degenerative MMPRTs performed between 1999 and 2010, were examined retrospectively. The modified Lysholm score was used for clinical evaluation. Cox proportional hazards regression analysis was used to assess factors that affect joint survivorship when conversion to total knee arthroplasty (TKA) was taken as the endpoint; these factors were age, sex, body mass index (BMI), preoperative tibiofemoral alignment (varus [Results: Mean age at the time of surgery was 58.9 years (range, 43-78 years). Sixty (20.8%) patients underwent TKA at 7.0 ± 3.6 years (range, 1.1-14.4 years) postoperatively. The mean follow-up time for those who did not undergo TKA was 8.9 ± 2.9 years (range, 4.5-16.5 years). The overall modified Lysholm score improved from 64.4 to 81.3 ( P < .001), but progression of radiographic arthritis was noted in 156 (61.9%) patients ( P < .001) at 2 years postoperatively. Age (hazard ratio [HR] = 1.049), BMI (HR = 1.092), varus alignment (HR = 2.283), and Kellgren-Lawrence grade 2 or higher (HR = 2.960) were significant risk factors for end-stage arthritis requiring TKA. Well-aligned nonarthritic knees (n = 131, 45.5%) survived significantly longer before requiring TKA than did knees with varus alignment or radiographic arthritis ( P < .05). The 5- and 10-year survival rates in these low-risk groups were 97.7% (95% CI, 95.2%-100.2%) and 89.1% (95% CI, 82.4%-95.8%), respectively. Conclusion: Arthroscopic meniscectomy is an effective treatment for degenerative MMPRTs, with favorable long-term survival in well-aligned nonarthritic knees. However, meniscectomy should be undertaken cautiously in patients with varus alignment and preoperative radiographic osteoarthritis.

Objective: Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy. Methods: Ninety patients who underwent arthroscopic meniscectomy were enrolled in the study. Group T was given tramadol, Group K was given ketamine, and Group M was given magnesium reconstituted intraarticularly, and all groups received periarticular bupivacaine. Comparisons were made in terms of the patients’ postoperative Visual Analogue Scale scores with and without movement, need for additional analgesics, first analgesic time, mobilization times, adverse effects, and satisfaction with the analgesics. Results: The Visual Analogue Scale scores were lowest in Group T at 0 minutes, and were higher in the 15th and 30th minutes and 1st, 2nd, and 6th hours. Visual Analogue Scale values with movement were found to be high in Group M at 0 and 15 minutes, but they were found to be higher in group T in the 30th minute, 1st, 2nd and 6th hour. The groups were similar in terms of postoperative additional analgesic use, number of analgesic use, and satisfaction with analgesics; however, the first analgesic time was earlier in Group M, and the first mobilization time was earlier in Group K. Conclusion: Intraarticular ketamine enables early mobilization and less need for additional analgesics, it also provides a better analgesic effect in comparison with intraarticular tramadol and magnesium. Resumo: Objetivo: O controle da dor pós-operatória é importante para recuperação e reabilitação precoces em meniscectomia artroscópica. Portanto, nosso objetivo foi comparar os efeitos de tramadol, magnésio e cetamina administrados por via intra-articular em associação com bupivacaína pericapsular sobre a dor e a recuperação após meniscectomia artroscópica. Métodos: Noventa pacientes submetidos à meniscectomia artroscópica foram incluídos no estudo. O Grupo T recebeu tramadol, o Grupo K recebeu cetamina e o Grupo M recebeu magnésio em doses reconstituídas por via intra-articular e todos os grupos receberam bupivacaína por via periarticular. As avaliações foram feitas mediante comparação dos escores em escala visual analógica no pós-operatório dos pacientes em movimento e em repouso, necessidade de analgésicos adicionais, tempo até a primeira necessidade de analgésico, tempo de mobilização, efeitos adversos e satisfação com os analgésicos. Resultados: Os escores da escala visual analógica foram menores no minuto zero e maiores nos minutos 15 e 30 e nas horas 1, 2 e 6 no Grupo T. Os escores da escala visual analógica em movimento foram maiores nos minutos zero e 15 no Grupo M e maiores no minuto 30 e nas horas 1, 2 e 6 no Grupo T. Os escores dos grupos foram semelhantes em relação à necessidade de analgésico adicional no pós-operatório, ao consumo de analgésico e à satisfação com os analgésicos, mas os tempos até a primeira necessidade de analgesia e até a primeira mobilização foram mais curtos nos grupos M e K, respectivamente. Conclusão: A administração intra-articular de cetamina permite mobilização precoce e diminui a necessidade de analgésicos adicionais, além de proporcionar um melhor efeito analgésico em comparação com tramadol e magnésio por via intra-articular. Keywords: Intraarticular analgesia, Ketamine, Tramadol, Magnesium, Knee arthroscopy, Palavras-chave: Analgesia intra-articular, Cetamina, Tramadol, Magnésio, Artroscopia de joelho

Highlights • Partial-thickness radial tears in the inferior surface of lateral meniscus are relatively rare. • Because the superior surface of the meniscus is intact, it may results in misdiagnosis. • Here, this case reports a partial-thickness radial tear of the lateral meniscus. • This situation was similar to PASTA (partial articular supraspinatus tendon tear) rotator cuff tear., Introduction We report a relatively rare case of partial-thickness radial tear in the inferior surface of lateral meniscus, while the superior surface is intact. This situation was similar to PASTA rotator cuff tear. Meanwhile, there is a full-thickness radial tear in the edge. Case presentation A 17-year-old boy twisted the left knee while playing basketball. Magnetic resonance imaging (MRI) revealed radial tear of the lateral meniscus. During arthroscopy, it was found that there was a full-thickness radial tear of about 2 mm located in the edge. Partial meniscectomy was performed to treat radial meniscal tear located in the white area. After that, we found that the superior surface of the lateral meniscus was intact. However, in the inferior surface of the lateral meniscus, partial-thickness radial tear was found extending to red zone. We used FASTFIX (Smith & Nephew) for all-inside suture. As of three months after this surgery, the patient recovered smoothly. Discussion Suspect that the force acts on a special position of meniscus and the thickness of the meniscus is uneven. Thus, it leads to partial-thickness radial tear in the inferior-surface, while the superior surface is intact. Conclusion Partial-thickness radial tears in the inferior surface of lateral meniscus are relatively rare. This situation was similar to PASTA rotator cuff tear. Because the superior surface of the meniscus is intact, it may results in misdiagnosis. It's easy to ignore the inferior surface injury.

To define arthroscopic meniscectomy (AM) outcomes in young patients at 20 years follow up in terms of predictors of poor clinical results, rate and timing of conversion to total knee replacement (TKR).The following data were collected for 225 patients aged between 18 and 50 years with meniscal tear (MT) who underwent AM: age at surgery, gender, injured meniscus, knee alignment, associated lesions, amount of meniscal resection. At 20 years follow up, rate and timing of TKR conversion and clinical outcomes with Knee injury and Osteoarthritis Outcome Score (KOOS) score were reviewed.Ten patients (4.4%) required TKR in the follow up period. The mean time from AM to TKR was 7.0 years (standard deviation 3.87). Age between 40 and 50 years at AM (P 0.01), malalignment (P 0.01), lateral meniscectomy (any size, P = 0.01), advanced chondral lesion (Outerbridge 2, P 0.01) and total meniscectomy (P 0.01) were significantly related to subsequent TKR. Negative predicting factors to obtaining equal or superior to age/sex-adjusted KOOS score were age between 40 and 50 years old at time of AM (P 0.01), female sex (P 0.01), malalignment (P = 0.04), and advanced chondral lesion (Outerbridge 2, P = 0.02).Twenty years conversion rate to TKR after AM for MT is 4.4% and TKR was performed after a mean time of 7 years. Significant association between TKR surgery and advanced chondral lesion (Outerbridge 2), total meniscectomy, lateral meniscectomy, age at surgery between 40 and 50 years old, and malalignment were found. Age between 40 and 50 years at time of AM, female, malalignment, advanced chondral lesion were all factors significantly related to poor clinical results.

Problems related to the meniscus, which has an extremely important place in lower extremity functions, are being seen at increasing rates with the current rates of sporting activities and intense working tempo. The leading problem is meniscus tears, and these create loss of workforce and a serious impairment to quality of life. Several different treatment protocols can be applied to meniscus tears, including conservative observation, repair, and open or arthroscopic meniscectomy. Which treatment should be applied in which circumstances varies according to the patient and the form of the meniscus tear. Currently, repair of a torn meniscus with newly developed surgical techniques and preservation of the meniscus should always be the first treatment plan [1–3].

Despite its widespread use and low complication rates, arthroscopic meniscectomy has not been uniformly successful in all patients, especially in those with concurrent osteoarthritis. The Patient-Reported Outcomes Measurement Information System (PROMIS) is an initiative funded by the National Institutes of Health to develop and validate patient-reported outcomes for clinical research and practice. PROMIS has shown the ability to enhance and standardize measurement of a variety of health domains affecting musculoskeletal function and in discriminating between various orthopaedic procedures through the use of computer adaptive testing. Preoperative PROMIS scores are valid predictors of postoperative minimal clinically important difference in patients undergoing arthroscopic meniscectomy based on preoperative decreased physical function and increased pain interference. PROMIS score cutoffs may be used by arthroscopic surgeons to counsel patients considering arthroscopic meniscectomy.

Arthroscopic meniscectomy (APM) is the most common procedure in orthopedic surgery, despite increasing evidence questioning its benefit over conservative management for treatment of degenerative meniscal tears. The purpose of this study is to determine the epidemiology and trends of APM in Saskatchewan, a Canadian province, over a 20 year period. Physician billing codes were used to identify patients who underwent APM in Saskatchewan between January 1, 1998 and December 31, 2017. Records were obtained from eHealth Saskatchewan, a provincial health database. Data was analyzed for overall incidence and age-specific trends of APM. A total of 35,099 APMs were performed during the study period. The population of Saskatchewan ranged from 992,314 to 1,150,782 (median 1,017,368) during this time interval, with 81 orthopedic surgeons performing APM. Overall incidence rate of APM did not change significantly over time. No decrease was observed in patients presumed to have degenerative tears (≥ 50 years). The number of meniscectomies in patients ≥ 50 years was significantly greater during the second decade of study compared to the first (OR 1.48, p

The objective of this study was to examine the relationship between cartilage degeneration early after partial medial meniscectomy and abnormal alignment in the lower extremity. The subjects were 34 patients (37 knees) with medial meniscal tear who underwent arthroscopic partial meniscectomy. MRI was performed before and 6 months after surgery. T2 mapping images in sagittal sections of medial femoral condyle were produced and 10 regions of interest were set at intervals of 10° in the articular cartilage in the femur. Subjects with an increase in T2 of ≥6% at a flexion angle of 30° were assigned to the degeneration group. Patient background, hip-knee-ankle (HKA) angle, and total resection of meniscal segments were compared between this group and the other patients to identify factors involved in degeneration of articular cartilage. T2 values 6 months after surgery in 3 ROIs at flexion angles of 30° to 50° were significantly longer than those before surgery. The preoperative HKA angle was significantly higher in the degeneration group. T2 values in articular cartilage of the femoral condyle increased earlier after meniscectomy with abnormal alignment in the lower extremity. Meniscectomy in cases with abnormal alignment may have a risk of early onset of osteoarthritis. Level of evidence: Level IV

Objectives Alternatives to tourniquets include portal-site epinephrine injections. This prospective, randomised-controlled, double-blinded study compared intraoperative visibility and safety of portal-site injections with tourniquets in arthroscopic meniscectomies. Methods Sixty eligible adults [16-55ys, excluding vascular/neuromuscular/systemic illnesses] were randomly/equally divided across 3 groups A (controls)-local portal injections; B-local injections with tourniquet; C-local and 1:200,000epinephrine injections. A single surgeon operated blinded to patient group. Intraoperative visibility, surgeon visual analogue score (VAS)and other details were recorded. Results Superior visibility [p = 0.003,p = 0.027] and VAS [p = 0.010,p = 0.042] were reported in groups B, C versus A, Visibility [p = 0.705; p = 0.805] and operating times [p = 0.05] were comparable between B and C. Conclusions Portal-site epinephrine injections emerged as tenable surrogates for tourniquets for clear visualization in arthroscopy.

Background/objective: Arthroscopic surgery in knee osteoarthritis is controversial with many studies refuting its efficacy in recent literature. This study aims to evaluate the mean duration to knee arthroplasty, and the effect of microfracture on the need for subsequent knee arthroplasty in patients above the age of 55 undergoing arthroscopic procedures for osteoarthritis. Methods: One hundred and nine consecutive patients with diagnosed osteoarthritis who underwent arthroscopic surgery performed from January 2000 to December 2012 on patients aged 55 years and above by a single surgeon were reviewed retrospectively. Demographic data, age at operation, comorbidities, perioperative details and information of subsequent total knee arthroplasty were collected and analysed. Results: There were 38 males and 71 females in our study group. The group was predominantly Chinese (51.38%), with hypertension and hyperlipidaemia being the most common comorbidities, each affecting 57.8% of our study cohort. All patients had a preoperative radiograph and a magnetic resonance imaging confirming the diagnosis of osteoarthritis associated with meniscal tears. Fifty-eight knees underwent microfracture along with arthroscopic meniscectomy. The mean follow-up duration was 127.5 months (10.5 years, range: 67–212 months). Twenty three patients (20.91%) underwent knee arthroplasties subsequently, with the mean duration to arthroplasty being 65.0 months (5.5 years, range: 7–166 months). The odds ratio of avoiding knee arthroplasty with microfracture was 1.03 (95% CI = 0.410–2.581). Conclusion: Arthroscopic procedures could possibly delay the need for subsequent knee arthroplasty for approximately 65 months in older patients with osteoarthritis. However, microfracture does not affect the duration between therapeutic arthroscopy and subsequent arthroplasty. Our long-term retrospective study provides an additional step in the understanding of the impact of arthroscopic procedures and a prospective case–control study would be an ideal follow-up to fully justify the application of arthroscopic procedures to delay knee arthroplasty.

Knee arthroscopy has evolved greatly from its inception in the twentieth century. Of the many arthroscopic knee surgeries, meniscectomy is the most commonly performed. Arthroscopic meniscectomy is the most common orthopaedic surgical procedure performed in the United States. We continue to develop more minimally invasive procedures, and the NanoScope has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and with the use of nanoinstruments, we can perform treatments as well as diagnostic arthroscopy without incisions. This technique provides an updated incisionless option to perform a partial medial meniscectomy.

Purpose To identify the current opioid prescribing and use practices after arthroscopic meniscectomy and to evaluate the role of preoperative patient education in decreasing postoperative opioid consumption. Methods Patients undergoing arthroscopic meniscectomy were prospectively identified for inclusion. They were placed into 1 of 2 groups: Group 1 received no education regarding opioid use after surgery, whereas group 2 received a standardized overview on postoperative opioid use. Patients were assigned to the groups consecutively: Patients treated at the beginning of the study were assigned to group 1, and patients treated at the end of the study were assigned to group 2. Data from group 1 were used to identify "normal" opioid prescribing and use practices and to guide patients in group 2 regarding normal postoperative opioid use. Patients were surveyed weekly for 4 weeks after surgery to determine the number of opioids taken. Postoperative opioid consumption was analyzed and compared between the 2 groups. Results A total of 62 patients completed the study (32 in group 1 and 30 in group 2). Patients in group 1 were prescribed an average of 42.0 opioid pills (95% confidence interval [CI], 34.0-51.0 pills) and used an average of 15.84 pills (95% CI, 9.26-22.4 pills) after surgery, whereas patients in group 2 used an average of 4.00 pills (95% CI, 2.12-5.88 pills) after surgery. Patients in group 2 used 11.84 fewer opioid pills (P = .001), a 296% decrease in postoperative opioid consumption. The number of patients who continued to take opioid pills 4 weeks after surgery was 7 patients (21.9%) in group 1 and 1 patient (3.3%) in group 2. Conclusions Preoperative patient education regarding opioids may decrease postoperative opioid consumption and the duration for which patients take opioid pills after arthroscopic meniscectomy. Level of Evidence Level II, prospective comparative study.

Arthroscopic partial meniscectomy (APM) continues to be the popular treatment for meniscal tears, but recent randomized controlled trials have questioned its efficacy. To provide more evidence-based criteria for patient selection, we undertook this study to identify prognostic factors associated with clinical failure after APM for medial meniscus tears.Medical records of 160 patients followed up for at least 5 years after APM for medial meniscal tears were retrospectively reviewed. Demographic data (age, sex, and body mass index), radiographic variables (Kellgren-Lawrence [K-L] grade and hip-knee-ankle [HKA] angle), and clinical scores (International Knee Documentation Committee score, Tegner activity scale score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score) were recorded. Clinical failure was defined as the need for an additional surgical procedure (arthroscopy, osteotomy, or arthroplasty) or the presence of intolerable pain. Survivorship analysis with clinical failure as an end point was performed using Kaplan-Meier survival curves. Factors related to clinical failure were analyzed using a Cox proportional hazard model. Cutoff values were determined using areas under receiver operating characteristic (ROC) curves. Radiographic progression of osteoarthritis was analyzed using the chi-square test, and serial changes of clinical scores were analyzed using a linear mixed model.Clinical success rates were 95.7% at 5 years, 75.6% at 10 years, and 46.3% at 15 years. Age, HKA angle, and K-L grade (The poor prognostic factors found to be related to clinical failure after APM for a medial meniscal tear were patient age (≥ 50 years), preoperative K-L grade (≥ grade 2), and preoperative HKA angle (≥ varus 5.5°).