Knee arthroscopy is a very common Orthopaedic procedure. Recent research has helped to define the role of knee arthroscopy, with indications for this procedure becoming more narrow. Based on the 2017 position statement from the Arthroscopy Association of Canada concerning arthroscopy of the knee joint, research has shown that knee arthroscopy should not be performed in the majority of patients with degenerative meniscal tears, given non-operative treatment results in equivalent outcomes. Additionally, it has been demonstrated that knee arthroscopy does not provide any benefit over non-operative measures in individuals with knee osteoarthritis lacking mechanical symptoms. Given the finite availability of operating room time and the risks associated with surgery, it is crucial that patients undergo knee arthroscopy appropriately to ensure safe, timely, and cost-effective care. The senior author of this study anecdotally noted a number of knee arthroscopies occurring for potentially inappropriate indications. This retrospective chart review evaluated the appropriateness of knee arthroscopies performed in a large non-academic Canadian city in 2018 and 2022. The senior author gave a presentation on the appropriateness of knee arthroscopy to his local Orthopaedic Surgery Division in 2019. To evaluate any changes in practice after this presentation, a list of all knee arthroscopies performed in 2018 and 2022 was obtained, excluding ligamentous reconstructions and osteotomies. Arthroscopies were classified as “appropriate,” “may be appropriate,” and “rarely appropriate.” Criteria for these classifications can be seen in Figure 1. Two independent reviewers conducted a subset analysis of the “may be appropriate” group, using the Kellgren-Lawrence scale to evaluate the degree of pre-operative arthritis seen on knee radiographs. These charts were then classified as “likely appropriate” if both X-ray and MRI images showed mild (grade one-two) arthritis, or “likely inappropriate” if either imaging modality showed moderate-severe (Grade three-four) arthritis. Of the 1378 charts included in this study, 726 were found to be appropriate (52.7%), 519 were labeled as may be appropriate (37.7%), and 133 were considered to be rarely appropriate (9.7%). In the subset analysis, 142 (27.4%) and 146 (28.1%) additional charts were found to be likely inappropriate by each reviewer, respectively. Weighted Cohen's Kappa demonstrated strong agreement between the raters (κ = .626). Combined with the initial results, a total of 275 (20.0%) or 279 (20.2%) knee arthroscopies were likely inappropriate. Approximately one in five knee arthroscopies were likely inappropriate, the primary reasons being arthroscopy for arthritis alone, degenerative meniscal tears with severe background arthritis, and concomitant steroid injection. The results of this study will be used to educate Orthopaedic Surgeons in the aforementioned non-academic Canadian city regarding their personal practice habits, surgical best practice, and health resource stewardship. For any figures or tables, please contact the authors directly.
Downey et al. (Wed,) studied this question.