Abram SGF, et al. - Since published clinical trial evidence over the past 6 years has raised questions about the efficacy of arthroscopic partial meniscectomy in some patients and there are concerns about possible overuse, researchers ascertained the true risk of serious complications following arthroscopic partial meniscectomy. They found the risk for complications was low for those undergoing arthroscopic partial meniscectomy. However, the procedure was related to some rare but serious complications (including pulmonary embolism and infection), and no decline in the risks has been seen over time.

Methods

• Excluding simultaneous or staged (within 6 months) bilateral cases, researchers analyzed national Hospital Episode Statistics data for all arthroscopic partial meniscectomies done in England between April 1, 1997, and March 31, 2017.
• They identified complications developing in the 90 days following the index procedure.
• The occurrence of at least one serious complication within 90 days (which was defined as either myocardial infarction, stroke, pulmonary embolism, infection requiring surgery, fasciotomy, neurovascular injury, or death) was the primary outcome.
• They determined factors associated with complications by using logistic regression modelling and, when possible, compared risk with general population data.

Results

• For analysis, 699,965 were eligible out of 1,088,782 arthroscopic partial meniscectomies performed.
• They noted the occurrence of serious complications within 90 days in 2,218 (0.317% [95% CI 0.304–0.330]) cases, including 546 pulmonary embolisms (0.078% [95% CI 0.072–0.085]) and 944 infections necessitating further surgery (0.135% [95% CI 0.126–0.144]).
• They observed an increased risk of serious complications in relation to increasing age (adjusted odds ratio [OR] 1.247 per decade [95% CI 1.208–1.288) and modified Charlson comorbidity index (adjusted OR 1.860 per 10 units [95% CI 1.708–2.042]).
• Findings showed a reduced risk of serious complications in relation to female sex (adjusted OR 0.640 [95% CI 0.580–0.705).
• A fall in the risk of mortality was also observed over time (adjusted OR 0.965 per year [95% CI 0.937–0.994]).
• A less frequent occurrence of mortality, myocardial infarction, and stroke was observed in the study cohort vs in the general population.
• No change was observed in the risks of infection and pulmonary embolism during the study, and these were found to be remarkably higher in the study cohort vs in the general population.
• They could prevent one pulmonary embolism for every 1,390 (95% CI 1,272–1,532) fewer knee arthroscopies done.
• Results showed that, for every 749 (95% CI 704–801) fewer procedures done, one native knee joint infection could be prevented.