15-Year-Experience of a Knee Arthroscopist: From Diagnostic to Reconstructive Surgery

OBJECTIVES: Arthroscopic knee surgery is a an experience-demanding procedure throughout diagnostic and reconstructive parts. Altough the literature says that there must be no need for diagnostic arthroscopy today, most arthroscopic surgeons have gained experience and developed themselves by the help of diagnostic arthroscopy and some basic procedures like debridement and lavage. The purpose of this study was to observe what happenned in the 15-year-experience of an orthopaedic surgeon who deals with knee arthroscopy. The hypothesis was that the mean age of the patients, who have undergone arthroscopic procedures, would decrease, and the percentage of the diagnostic and debridement applications would diminish and reconstructive procedures would increase. METHODS: For this purpose, 959 patients who have undergone knee arthroscopy in 15 years, were evaluated retrospectively. The gender, age, operation year and the procedure applied for the patients were enrolled on an Excel file. Chi-Square test was used for statistical evaluation. The patients were divided into three groups according to the year they were operated. Period 1 included the patients who were operated between the years 1999-2003, Period 2 between 2004-2008 and Period 3 between 2009-2013. According to their ages, the patients were evaluated in three groups; Group 1 included the patients ≤ 25 years old while Group 2 between 26-40 and Group 3 ≥ 41. Arthroscopic procedures were evaluated in three groups: Group X: meniscectomy, chondral debridement, lavage, synoviectomy, loose body removal. Group Y: ACL and PCL reconstruction, meniscal repair. Group Z: Microfracture, lateral release, meniscal normalization, second look arthroscopy, diagnostic arthroscopy before osteotomy. RESULTS: Among all patients, 60 % was male and Group 3 (45.4 %) was the larger group in population. The procedures in Group X were used in most of the operations ( 59.2 %). The population of the patients in the periods increased gradually throughout the years: 24 % in Period 1, 36.6 % in Period 2 and 39.4 % in Period 3. While the population of Group 3 was higher than the others in the first two periods, Group 2 was the leader in the last period (p< 0.001). While male/female ratio was statistically insignificant in Periods 1 and 2, the number of the males in Period 3 was statistically higher than the females (p< 0.001). The procedures in Group Y were used significantly for males in Periods 2 and 3 (p< 0.001). The procedures in Group X were used significantly for females (p< 0.001) while the ones in Group Y were applied for males (p< 0.001). Among all arthroscopic procedures, Group X was the leader in Period 1 (85 %) but this frequency decreased throughout the years and the procedures in Group Y increased gradually more than twice consisting more than half of the procedures in Period 3 (p< 0.001). CONCLUSION: Throughout the years, the age of the patients, for whom arthroscopic procedures were done, and the percentage of debridement and diagnostic procedures have decreased, while the population of the patients and the number of the reconstructive procedures, especially for males, have increased. The results were statistically significant. In our opinion, this statistical conclusion must be the usual academic development of an orthopeadic surgeon who deals mostly with knee arthroscopy in his daily practice. This must be a guide for young arthroscopists.