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Increase in Outpatient Knee Arthroscopy in the United States: A Comparison of National Surveys of Ambulatory Surgery, 1996 and 2006

Kim, Sunny PhD; Bosque, Jose MD; Meehan, John P. MD; Jamali, Amir MD; Marder, Richard MD

Journal of Bone & Joint Surgery - American Volume: 1 June 2011 - Volume 93 - Issue 11 - p 994–1000
doi: 10.2106/JBJS.I.01618
Scientific Articles

Background: This study was proposed to investigate the changes in the utilization of knee arthroscopy in an ambulatory setting over the past decade in the United States as well as its implications.

Methods: The National Survey of Ambulatory Surgery, last carried out in 1996, was conducted again in 2006 by the Centers for Disease Control and Prevention. We analyzed the cases with procedure coding indicative of knee arthroscopy or anterior cruciate ligament reconstruction. To produce estimates for all arthroscopic procedures on the knee in an ambulatory setting in the United States for each year, we performed a design-based statistical analysis.

Results: The number of arthroscopic procedures on the knee increased 49% between 1996 and 2006. While the number of arthroscopic procedures for knee injury had dramatically increased, arthroscopic procedures for knee osteoarthritis had decreased. In 1996, knee arthroscopies performed in freestanding ambulatory surgery centers comprised only 15% of all orthopaedic procedures, but the proportion increased to 51% in 2006. There was a large increase in knee arthroscopy among middle-aged patients regardless of sex. In 2006, >99% of arthroscopic procedures on the knee were in an outpatient setting. Approximately 984,607 arthroscopic procedures on the knee (95% confidence interval, 895,999 to 1,073,215) were performed in an outpatient setting in 2006. Among those, 127,446 procedures (95% confidence interval, 95,124 to 159,768) were for anterior cruciate ligament reconstruction. Nearly 500,000 arthroscopic procedures were performed for medial or lateral meniscal tears.

Conclusions: This study revealed that the knee arthroscopy rate in the United States was more than twofold higher than in England or Ontario, Canada, in 2006. Our study found that nearly half of the knee arthroscopic procedures were performed for meniscal tears. Meniscal damage, detected by magnetic resonance imaging, is commonly assumed to be the source of pain and symptoms. Further study is imperative to better define the symptoms, physical findings, and radiographic findings that are predictive of successful arthroscopic treatment.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, University of California-Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817. E-mail address for S. Kim: sunny.kim@ucdmc.ucdavis.edu

2Department of Orthopaedic Surgery, University of California-Davis, 2805 J Street, Suite 300, Sacramento, CA 95816

Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated
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