Avoiding and Managing Complications Associated with Arthroscopic Knee Surgery: Miscellaneous Knee Conditions

Abstract

Secondary to improvements in instrumentation, operative techniques and surgeon experience, knee arthroscopy has gained significant popularity amongst orthopedists for the management of a variety of pathologic conditions affecting the knee. In the United States, knee arthroscopy is the most commonly performed operative orthopedic procedure, with more than 2 million cases occurring annually.¹–⁵ As the indications for operative knee arthroscopy have increased, so have complications associated with the surgery. Although the vast majority of knee arthroscopic procedures occur without incident, recent reports have cited complication rates ranging from <1% to 8% of cases.¹,⁴,⁶–⁹

Arthrofibrosis, infection, osteonecrosis/bone marrow edema syndrome, broken/retained hardware, and issues with portal healing are among the possible complications associated with arthroscopic knee procedures. The following chapter reviews each of these potential problems associated with operative knee arthroscopy and provides suggestions for appropriate management.

Editors’ Comments (Misc.)

Arthrofibrosis

Prevention: We have found that use of a locked extension brace at night helps avoid postoperative loss of extension, intercondylar notch scarring, or cyclops formation. The brace is set in the OR to equal the extension or even hyperextension of the opposite normal knee. The brace is utilized at all times during the first 2–3 weeks when the patient is not otherwise doing range of motion exercises and physical therapy. If a patient still has difficulty maintaining postoperative extension, we have had success utilizing a knee extension board (Instrument Maker), which is provided to the patient for home use.

Treatment of Arthrofibrosis

If a patient loses motion after surgery and surgical treatment is undertaken, the approach needs to be comprehensive and needs to address both flexion and extension deficits. To regain flexion, release of the supra patella pouch, medial, and lateral gutters and possibly retinacular releases are often necessary. If the graft itself is poorly placed, in rare cases the graft will need to be released or removed. To regain extension, the surgeon will need to clear out the intercondylar notch to ensure that there is no mechanical block anteriorly preventing extension. If this is still not effective, the posterior capsule is often the culprit, particularly if a meniscus repair was done, which may capture the capsule. In this instance, the surgeon needs to be prepared to perform a posterior capsular release. This is performed arthroscopically in our hands, utilizing a posterior medial portal. Through this portal, the posterior medial and posterior lateral capsule can be released by penetrating through the septa behind the PCL, while viewing with the arthroscope through the notch.