Risks and Complications Associated With Intra-articular Arthroscopy of the Knee and Shoulder in an Office Setting

Abstract

Background: Classically, arthroscopy has been considered one of the diagnostic gold standards for assessing intra-articular knee and shoulder abnormality.

Purpose: To assess the risks associated with in-office needle arthroscopy.

Study design: Case series; Level of evidence, 4.

Methods: A retrospective case series analysis was performed by evaluating consecutive diagnostic needle arthroscopies performed by 13 physicians at 13 independent institutions. The findings of both major and minor complications were reported by each of the 13 surgeons based on office documentation. The data were analyzed as a lump sum of both knee and shoulder cases and then subdivided and examined separately. The patients' ages ranged from 14 to 78 years, and no statistical difference was noted between the numbers of men and women. A major complication was defined as infection, chondral toxicity, or the need for alternative treatment at an urgent care or emergency room secondary to the procedure. Minor complications were defined as a vasovagal event, pain that persisted after 24 hours, or the need for crutches or sling postprocedure.

Results: Of the 1419 cases, no major complications were reported. The overall rate of vasovagal events was 1.9% for all procedures (1.6% in knees, 3% in shoulders). Persistent pain longer than 24 hours postprocedure was reported in 0.3% of cases. No patient required crutches or a sling. Postarthroscopy magnetic resonance imaging was needed in 1.4% of cases. No device failures were reported.

Conclusion: Previous literature has evaluated the efficacy, sensitivity, and specificity of in-office diagnostic arthroscopy, and this study validates needle arthroscopy as safe in the office setting, with minimal risk of major or minor complications.

Keywords: Outpatient; clinic; diagnostic arthroscopy; needle arthroscopy.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.M. has received hospitality payments from Stryker and consulting fees from Arthrex, C.R. Bard, Exactech, DePuy Mitek, Linvatec, Rotation Medical, Smith & Nephew, Trice Medical, and Zimmer Biomet. A.C. has received educational support from Arthrex and Stryker and consulting fees from Arthrex, Cayenne Medical, Trice Medical, and Zimmer Biomet. N.H.A. has received research support from Pacira, Smith & Nephew, and Trice Medical; consulting fees from Biom’Up, DePuy, Pacira, Smith & Nephew, and Trice; and hospitality payments from Novadaq Technologies. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2019.

Figures

Figure 1.

The Mi-Eye2 system.

Figure 2.

Example of aseptic preparation of a right knee by use of superolateral, medial, and lateral portal sites with alcohol and Betadine (Avrio Health).