Abstract. Introduction. Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons. Methods. At a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centering and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies, and meniscectomy. Pre and post-experience questionnaires and quantitative repeat analysis on simulation exercises were undertaken to identify levels of improvement. Results. Comparing pre and post-experience questionnaires significant improvements in levels of confidence were noted in the following domains: naming arthroscopic instruments, port positioning and insertion, recognising normal anatomy arthroscopically, holding and using arthroscopic instruments and assisting in a live theatre setting (p<0.05). Significant improvements were noted in time taken to complete, distance covered in metres and roughness of instruments used on the simulated exercises on repeat performance (p<0.05). Conclusion. With only five sessions under senior guidance, using a simulator such as the ARTHRO Mentor, significant improvements in both levels of confidence and skill can be developed even among individuals with no prior experience

Introduction. Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons. Methods. At a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centring and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies and meniscectomy. Pre and post experience questionnaires and quantitative repeat analysis on simulation exercises were undertaken to identify levels of improvement. Results. Comparing pre and post experience questionnaires significant improvements in levels of confidence were noted in the following domains: naming arthroscopic instruments, port positioning and insertion, recognising normal anatomy arthroscopically, holding and using arthroscopic instruments and assisting in a live theatre setting (p<0.05). Significant improvements were also noted in time taken to complete and distance covered in metres, of the simulated exercises on repeat performance (p<0.05). Conclusion. Overall, with only five sessions under senior guidance, using a simulator such as the ARTHRO Mentor, significant improvements in both levels of confidence and skill can be developed even among individuals with no prior experience

Knee arthroscopy with debridement is commonly performed to treat osteoarthritis and degenerative meniscal tears in older adults; however robust evidence does not support sustained benefit from this procedure. Current Canadian guidelines advise against its use as first line treatment. Characterizing the use of this low value procedure will facilitate efforts to maximize quality of care, minimize harm and decrease healthcare costs. We sought to understand:. 1). the volume and variations of arthroscopic knee debridement across Canada. 2). The costs associated with potentially unnecessary arthroscopy. 3). The characteristics of surgeons performing knee arthroscopy in older adults. Data were derived from National Ambulatory Care Reporting System (NACRS), the Discharge Abstract Database (DAD) and the National Physician Database for years 2011-12 to 2019-20. The study included all elective knee arthroscopies (CCI codes 1.VG.80.DA,1.VG.80.FY and 1.VG.87.DA) performed in day surgery and acute care settings in 9 provinces and 3 territories of Canada. Quebec was not included in the analysis due to different reporting methods. We set a threshold of 60 years of age at which it would be highly unlikely that a patient would undergo arthroscopy to treat anything other than osteoarthritis or degenerative meniscal tear. Trends at national and provincial levels were analyzed using regression. Costs were estimated separately using the 2020 case mix groups (CMG) and comprehensive ambulatory care classification system (CACS) methodologies. Surgeons were classified by decade of graduation from medical school (1989 and prior, 1990-99, 2000-09 and 2010+) and categorized based on the proportion of their patient population who were above (“high proportion inappropriate”) or below (“low proportion inappropriate”) the overall national proportion of ≥ 60 years of age. The number of knee arthroscopies decreased by 37% (42,785 in 2011-12 to 27,034 in 2019-20) overall and 39% (11,103 in 2011-12 to 6,772 in 2019-20) in those 60 years and older (p 25% of patients 60 years and older. Fifty four percent of surgeons who graduated prior to 1989 were considered high proportion inappropriate, whereas only 30.1% of surgeons who graduated in 2010 or later were considered high proportion inappropriate (p < 0 .0001). Knee arthroscopy continues to be a common procedure in patients over 60 despite strong evidence for lack of benefit. Lower rates in this population in some provinces are encouraging for potential opportunity for improvement. Efforts at practice change should be targeted at surgeons in practice the longest. Canada spends over $12,000,000 per year on this procedure, decreasing its use could allow these resources to be directed to other areas of orthopaedics that provide higher value care

Abstract. Background. Orthopaedic training in Southern Africa is largely focused on trauma, although elective procedures, such as knee arthroscopy are increasing. This is especially true in the private sector where most trainees will practice. The primary aim of this study was to assess the arthroscopic competency of orthopaedic trainees in a setting of limited resources. Methods. A prospective observational cohort study was carried out. Orthopaedic trainees of a Southern African university hospital performed basic arthroscopy on a knee model. Their surgical competency was assessed by two surgeons proficient in arthroscopy using the modified Basic Knee Arthroscopy Skill Scoring System (mBAKSSS). Results. A total of 16 trainees (12 male) were included (6 junior and 10 senior trainees). The median age of participants was 36 (34.8, 37). The median mBAKSSS was 28.0 (20.3, 32.5) but showed a large variability (12.0–42.5). The overall reliability was excellent with Cronbach's Alpha of 0.91 and interclass correlation of 0.91 [95% CI 0.75, 0.97]. Conclusions. The average knee arthroscopy proficiency of our trainees is comparable to those of international training programs, but there was great variability with inconsistent skills amongst the trainees. This calls for improved and reproducible arthroscopy training and skills transfer, exposure to procedures and ongoing assessment

Introduction and Aims: There has recently been a great deal of attention regarding medical errors. Wrong-site surgery is said to be a problem among orthopaedic surgeons, especially during knee arthroscopy. There has not been a survey to determine how often wrong-site knee arthroscopy occurs among arthroscopists practicing in the United States. Method: All 1575 active members of the Arthroscopy Association of North America practicing in the United States were polled, using a confidential survey. Each questionnaire had 13 questions and 29 data points requested. Information requested included age, years of practice and number of knee arthroscopies performed per year. In cases where wrong-site surgery had occurred, further information regarding permanent disability, monetary settlements, and legal action was requested. Surgeons were also asked if they were aware of the American Academy of Orthopaedic Surgeons’ ‘Sign Your Site’ Wrong-site Surgery Prevention program and if they had a routine or protocol to prevent wrong-site surgery. Results: 1301 surgeons (83%) responded. The average surgeon who responded was 48.2 years of age, had been in practice for 15.8 years, and performed 146 knee arthroscopies per year. One hundred and eight surgeons (8.3%) reported performing wrong-site surgery during a knee arthroscopy at least once during their career, for a total of 114 incidences of knee arthroscopy wrong-site surgery. In only two cases was the patient felt to have suffered a permanent disability. There was a monetary settlement in 58 cases (50%). Three cases went to court and all three were won by the plaintiff. There was a statistically significant positive correlation between knee arthroscopy wrong-site surgery and the surgeon’s age, years of practice and yearly knee arthroscopy case volume. The estimated incidence of knee arthroscopy wrong-site surgery in this group of surgeons was one per 27,000. Ninety-five percent of the respondents are aware of the American Academy of Orthopaedic Surgeons’ ‘Sign Your Site’ Wrong-site Surgery Prevention program. Ninety-six percent have a routine or policy to prevent wrong-site surgery. Conclusion: 8.3% or 108 of this group of 1301 experienced surgeons have performed wrong-site surgery during knee arthroscopy at least once during their career. There is a positive correlation between wrong-site surgery and the surgeon’s age, years of practice and yearly arthroscopy case load

Background: Tourniquet provides a blood less field for surgery, but it has few complications and contraindications. There are several studies identifying the tourniquet as a factor for increased risk of complications in knee arthroscopy, we reviewed 200 consecutive knee arthroscopies done in our hospital with out tourniquet to analyse the outcome. Aim: To analyse the out come of 200 knee arthroscopies with out use of tourniquet; with respect to visualisation, time of surgery, bleeding, analgesia and post operative complications. Materials and methods: We retrospectively analysed 200 consecutive knee arthroscopies with out tourniquet done in our institute. Average age of these patients was 39 (21–81). All patients underwent soft tissue procedures under general anaesthesia, supine, with sole support, no antibiotics and was done by same surgeon as day case. Same arthroscopic kit with pump was used for all patients, using 2 litre saline bag and pump set at 65 mm Hg pressure. First few cases had tourniquet applied but not inflated, but later even this was avoided. Procedures included were diagnostic arthroscopies, arthroscopic debridements, meniscal repairs and partial or complete meniscal resections. Procedures like arthroscopic ACL reconstruction and other bony procedures were excluded. We looked at any visualisation problems, time of surgery, bleeding, analgesia and post operative complications. We also looked weather any of these patients visited the consultant or GP for any wound related problem or pain before the usual review at 2 weeks. Results: There was no problem with visualisation noted in any of the cases, or any incidence where arthroscopy was unduly prolonged. There was no incidence of bleeding, stiffness or increased need for analgesia in any of these patients. None of the patients had any wound problem or haemathrosis requiring intervention. There was no record of any patients reattending the clinic or their GP for pain or bleeding. Conclusions: Many orthopaedic units continue to use a tourniquet routinely for soft tissue procedures in knee arthroscopy, probably in the belief that a clear operative view can only be achieved with one. However, the findings in our study indicate that knee arthroscopy for soft tissue procedures may be performed adequately without the use of a tourniquet provided a pump system is used and the pressure maintained above venous pressure. Therefore we recommend that its use for routine soft tissue arthroscopic procedures be discontinued

Background: Tourniquet provides a blood less field for surgery, but it has few complications and contraindications. There are several studies identifying the tourniquet as a factor for increased risk of complications in knee arthroscopy, we reviewed 200 consecutive knee arthroscopies done in our hospital with out tourniquet to analyse the outcome. Aim: To analyse the out come of 200 knee arthroscopies done with out use of tourniquet; with respect to visualisation, time of surgery, bleeding, analgesia and post operative complications. Materials and methods: We retrospectively analysed 200 consecutive knee arthroscopies with out tourniquet done in our institute. Average age of these patients was 39 (21–81). All patients underwent soft tissue procedures under general anaesthesia, supine, with sole support, no antibiotics and were done by same surgeon as day case. Same arthroscopic kit (Dyonics) with pump was used for all patients, using 2 litre saline bag and pump set at 65 mm Hg pressure. First few cases had tourniquet applied but not inflated, but later even this was avoided. Procedures included were diagnostic arthroscopies, arthroscopic debridements, meniscal repairs and partial or complete meniscal resections. Procedures like arthroscopic ACL reconstruction and other bony procedures were excluded. We looked at any visualisation problems, time of surgery, bleeding, analgesia and post operative complications. We also looked weather any of these patients visited the consultant or GP for any wound related problem or pain before the usual review at 2 weeks. Results: There was no problem with visualisation noted in any of the cases, or any incidence where arthroscopy was unduly prolonged. There was no incidence of bleeding, stiffness or increased need for analgesia in any of these patients. None of the patients had any wound problem or haemathrosis requiring intervention. There was no record of any patients reattending the clinic or their GP for pain or bleeding. Conclusions: Many orthopaedic units continue to use a tourniquet routinely for soft tissue procedures in knee arthroscopy, probably in the belief that a clear operative view can only be achieved with one. However, the findings in our study indicate that knee arthroscopy for soft tissue procedures may be performed adequately without the use of a tourniquet provided a pump system is used and the pressure maintained above venous pressure. Therefore we recommend that its use for routine soft tissue arthroscopic procedures be discontinued

Aims. Tourniquets have potential adverse effects including postoperative thigh pain, likely caused by their ischaemic and possible compressive effects. The aims of this preliminary study were to determine if it is possible to directly measure intramuscular pH in human subjects over time, and to measure the intramuscular pH changes resulting from tourniquet ischaemia in patients undergoing knee arthroscopy. Methods. For patients undergoing short knee arthroscopic procedures, a sterile calibrated pH probe was inserted into the anterior fascial compartment of the leg after skin preparation, but before tourniquet inflation. The limb was elevated for three minutes prior to tourniquet inflation to 250 mmHg or 300 mmHg. Intramuscular pH was recorded at one-second intervals throughout the procedure and for 20 minutes following tourniquet deflation. Probe-related adverse events were recorded. Results. A total of 27 patients were recruited to the study. Mean tourniquet time was 21 minutes (10 to 56). Tourniquet pressure was 300 mmHg for 21 patients and 250 mmHg for six patients. Mean muscle pH prior to tourniquet inflation was 6.80. Muscle pH decreased upon tourniquet inflation, with a steeper fall in the first ten minutes than for the rest of the procedure. Change in muscle pH was significant after five minutes of tourniquet ischaemia (p < 0.001). Mean muscle pH prior to tourniquet release was 6.58 and recovered to 6.75 within 20 minutes following release. No probe related adverse events were recorded. Conclusion. It is possible to directly measure skeletal muscle pH in human subjects over time. Tourniquet ischaemia results in a decrease in human skeletal muscle pH over time during short procedures. Cite this article: Bone Joint Res 2021;10(6):363–369

Clinical investigations and tests need to be validated by studying their inter-observer and intra-observer errors, but there has been no documentation of such verification in diagnostic knee arthroscopy. We performed a prospective study to find out to what extent the findings in knee arthroscopy differ between two different surgeons. Two senior specialist registrars (M.S. and A.J.) who took part in this study worked with the senior author (ACW) for a period of eight and seven months respectively. A total of 78 knee arthroscopies admitted from routine waiting list were studied. The specialist registrar first performed arthroscopy when the supervising consultant stayed away from the operating room. His findings were recorded on a proforma by an independent third person before the consultant returned to the operating room and repeated the EUA and arthroscopy without prior knowledge of the trainee findings. Findings from the consultant arthroscopy were then recorded separately on the same proforma. The following findings were recorded:. Examination under anaesthesia. Meniscal pathology. ACL pathology. Articular surface pathology (more than 1 Outer-bridge grade). The inter-observer variations in diagnostic knee arthroscopy were found to be high. Given the seniority and experience of the two trainee senior registrars involved in the study, and allowing for the Hawthorne effect, the results of the study cast doubt on this procedure being performed un-supervised. It also questions the validity of any therapeutic intervention based on the findings of un-supervised arthroscopies

Background: This study was carried out to record and compare the opinions of junior and senior orthopaedic surgeons with regards to the amount of training necessary to achieve competency in knee arthroscopy. Methods: At a recent international orthopaedic conference a questionnaire was given to 50 orthopaedic residents and 40 consultants. Consultants were also asked if they performed regular knee arthroscopy (> 50/year). Competency for this study was deWned as the ability to perform the procedure without supervision. Participants were asked to estimate the number of times a trainee needs to do the following procedures to achieve competency: diagnostic scope, partial medial meniscectomy, partial lateral meniscectomy, and anterior cruciate ligament (ACL) reconstruction. Results: Participants completed the questionnaire immediately ensuring a 100% response. Of the 40 consultants, 22 performed regular knee arthroscopy. The greatest similarity was between the opinions of the consultants who performed regular knee arthroscopy and the junior surgeons, for both diagnostic and partial medial meniscectomy. There was a substantial diVerence in opinion for partial lateral meniscectomy and ACL reconstruction, with junior surgeons estimating a much greater amount of practice being needed to achieve competency. Consultants who did not perform regular knee arthroscopy consistently estimated approximately half the number of operations when compared to others. Conclusions: The information presented in this study demonstrates the opinions of both junior and senior surgeons as to how many repetitions of four common arthroscopic procedures are necessary to achieve competency: this information may be useful in designing eVective arthroscopic training programmes

Purpose: To analyze the causes of repeat knee arthroscopy in the same knee. Materials and methods: We reviewed 923 patients that had undergone knee arthroscopy during 2005 and assessed those that had already undergone previous arthroscopy of the same knee that year or in previous years and analyzed the causes. Results: Of the 923 patients that required knee arthroscopy 169 (18.3%) had undergone previous surgery. Four (2.3%) had undergone 3 previous arthroscopies, 27 (15.9%) two and 138 (81.6%) one. In 59.8% of cases, the symptoms that led to repeat arthroscopy were non-traumatic continuous pain. The other cases required repeat arthroscopy due to new trauma, or meniscal or anterior cruciate ligament (ACL) tears. The patients with affected menisci (104) underwent partial meniscectomy, 31% had a posterior cruciate ligament (PCL) tear and 58% had menisci remains with or without osteochondral lesions. Repeat arthroscopies of ACL tears treated by ligamentoplasties (41) were due to plasty tears in 46% of cases and adhesions in 27%. In patients that underwent 3 arthroscopies, the main diagnosis was plasty tear in 45% of the total sum of 2. nd. and 3. rd. arthroscopies. Mean time between first and second arthroscopy was 28 months and between second and third arthroscopy 12 months. The relative risk of undergoing a new arthroscopy during the same year as meniscectomy was 1.12% and as ACL ligamentoplasty 0.95%. Conclusions: Not all repeat arthroscopies are caused by previous complications. The main clinical reasons for a repeat arthroscopy can be traumatic or non-traumatic, with a greater frequency of the latter. We found that the risk of repeat arthroscopy was greater during the first year in meniscal tears than in ACL tears

Aim. To find out the usefulness of knee arthroscopy with debridement in patients of 60 years or more. Materials and Methods. We retrospectively looked at the patients of 60 years or more age who under went knee arthroscopy between Jan 2012 and Dec 2012 and collected demographic data, indications for arthroscopy, grading of preoperative knee x-rays (Kellgren-Lawrence), intra-operative findings, post operative relief of symptoms and any further surgeries till the time of study. Results. n=58, mean age was 67.3 years (60 – 81), male: female ratio 36:26, side 26:36 (R: L). Mean follow up 14.8 weeks (2–52). Most common indication was medial meniscus pathology (60%). More than 50% of the cases were of Grade III and IV (Kellgren-Lawrence). Intra-operative findings showed 62% tri-compartment and 12% bi-compartment arthritic involvement. 59% had medial, 7% had lateral and 7% had both meniscus tears. 75% of the patients felt symptomatically better at the time of last follow up and only 14% of the patients under went arthroplasty till the time of study. Conclusion. We conclude that knee arthroscopy with debridement offers symptomatic relief in majority (75%) of patients of 60 years or more of age with only few (14%) requiring early arthroplasty

Purpose. The purpose was to determine if the use of cold irrigation fluid in routine knee arthroscopy leads to a reduction in post operative pain. Background. Some surgeons use cooled irrigation fluid in knee arthroscopy in the hope that it may lead to a reduction in post operative pain and swelling. There is currently no evidence for this, although there is some evidence to support the use of cold therapy post operatively in knee surgery. Methodology. We conducted a blind randomised controlled trial comparing the use of cooled (4°C) and room temperature irrigation fluid in routine arthroscopic knee surgery. Pain was recorded on a numerical scale (0 to 10) hourly for 3 hours post-operatively, at discharge and daily for 1 week. A detailed record of analgesic consumption was recorded. Patients were randomised into the cooled group (mean age 50.1 years) and the room temperature group (mean age of 46.1 years). Results. The average hourly difference in pain score for the first 3 hours post operatively was 0.12, 0.57, and 0.23 with reduced pain scores in the cooled fluid group, but this did not reach statistical significance. Total analgesic administration in theatre, recovery and the ward was lower in the cooled fluid group, as was the self administration of analgesia for the week after discharge. No increased complications where seen. Conclusion. No significant difference in patient reported pain scores has been demonstrated after the use of cooled irrigation fluid in routine knee arthroscopy. The tendency to a slight reduction in analgesic consumption in the cooled fluid group may have more significant benefits in complex arthroscopic knee surgery such as ligament reconstruction, this requires further study

Aims: Outpatient clinic follow-up of patients after knee arthroscopy is routine practice in many orthopaedic units. It can be inconvenient and expensive for patients and may be unnecessary.The aim of our study was to compare oupatient follow-up with telephone follow-up after knee arthroscopy in a prospective randomised trial. Patients and method: Over a four-month period, 50 patients (mean age 41 years) were included in our study. Each patient underwent a day-case knee arthroscopy as previously planned. After surgery, each patient was randomised to either attend for an outpatient clinic follow-up after two weeks or to receive a telephone follow-up after two weeks from operation. All patients were assessed after four weeks from surgery by an independent assessor who was blinded to the type of follow-up each patient had received. No patients in the study were lost to follow-up. Results: No significant difference was found in patient satisfaction scores between the outpatient and telephone groups (mean 7.78 vs mean 7.92). However, 81% patients in the telephone group and 57% patients in the clinic group (p< 0.01) preferred telephone follow-up if they were to undergo another knee arthroscopy. There was a significant increase in patello-femoral problems in those preferring outpatient follow-up (64%) compared to telephone follow-up (24%), p< 0.05. No difference in complication rates between the two groups was found. Conclusion: Telephone follow-up provides a satisfactory and safe alternative to outpatient follow-up after knee arthroscopy. It is preferred by the majority of patients and could relieve pressure on outpatient resources

Aim: To determine effect of single post-operative injection of Sodium Hyaluronate (Viscoseal) on the pain and joint function, following arthroscopic knee surgery. Method: Study design: A randomized, prospective, controlled, double blinded trial after ethical approval. Study procedure: Consenting patients (age group 18–60 years) undergoing arthroscopic knee surgery were randomized to either study group or control group, after the completion of their operation. Control group had 10 mls of 0.5% Bupivacaine injected in the joint after the procedure, while study group had 10 mls of Viscoseal (Sodium Hyaluronate preparation devoid of animal protein) injected in the joint. Patients were given questionnaires to assess their pain and function at various times (Preoperatively; 2 hour following surgery; Day 1, Day 7, 3 week and 6 week following surgery). Primary efficacy parameters used were Pain visual analogue scores at rest, on movement and on weight bearing. Secondary efficacy parameters used included WOMAC questionnaire, SF-12 general health questionnaire and use of rescue medication. Patients were evaluated clinically at 6 weeks by a blinded physiotherapist. Results: 48 patients (Average age-41 years, 20 female, 28 male) undergoing knee arthroscopy were randomized (24 patients each). The hyaluronate group exhibited markedly lesser degrees of immediate post-operative pain and swelling; reduced need for analgesics, and a significantly larger drop in WOMAC scores than the bupivacaine group (p< 0.05). SF-12 scores and delayed pain VAS score improved by a comparable amount. In particular, those undergoing partial meniscectomy exhibited greater benefits with hyaluronate. No complications were recorded in either of the groups. Conclusion: Sodium hyaluronate (Viscoseal) injections could be safely used following arthroscopic knee surgery, to facilitate patient’s recovery

Background: Arthroscopic visualisation of the postero-medial and posterolateral compartments of the knee through the intercondylar notch using the anterolateral and anteromedial portals respectively is not commonly practiced. The purpose of this study was to prospectively evaluate whether these views are useful either diagnostically, therapeutically or both in a routine knee arthroscopy. Patients and Methods: It is a prospective study of two hundred consecutive patients who underwent a routine knee arthroscopy in our unit using the standard portals following an appropriate clinical and radiological evaluation. Posteromedial and posterolateral compartment visualisation through the intercondylar notch was undertaken in all the patients. An evaluation of the ease of the technique, the usefulness of visualisation and the morbidity associated with the procedure were recorded. Results: The technique was deemed simple to perform in 91% of the patients. It was found to be more difficult in knees with degenerative joint disease. Posteromedial and posterolateral compartment visualisation was found to be useful for diagnosis or treatment in 15% and 6% of the diagnosed conditions respectively. The technique was most useful for tears of the posterior horn of the medial meniscus, most of which were not detected by visualisation from the anteromedial compartment alone. Visualisation of the compartments was deemed adequate in 98% of the patients. There was no morbidity associated with this procedure. Conclusion: We believe that visualisation of the pos-teromedial and posterolateral compartment in a routine knee arthroscopy is beneficial; and an easy and safe procedure to perform

Abstract. Introduction. Transforming outpatient services is a key commitment set out in the NHS Long Term Plan, with particular emphasis on digital solutions to reduce outpatient follow-up (FU) by 25%. This study looks at the potential for removing knee arthroscopy FU by providing a bespoke multimedia report for each individual patient, generated using the Synergy™ Surgeon App (Arthrex). Methodology. Single District Hospital using a 3 Phase study. Phase 1 – Assessment of cost and environmental impact of outpatient follow up appointments. Phase 2 – Bench marking of existing pathways and patient experience. Phase 3 – Qualitative assessment of multimedia report feedback of 30 patients. Results. Phase 1 – Impact per year for Trust in released clinician time 135hrs. Cost avoidance £40-£60k. Reduction of the carbon footprint from reduced FU of 3132 KgCo2e2. Phase 2 – Deep dive on 2019 n. 353 procedures. 1206 outpatient appointments required. Average 1.2 post-operative appointments. Phase 3 – 87% of patients who received the e-op report needed no further FU. This compares to only 25% using a traditional post op discussion after surgery. 94% of patients felt the report aided their recovery. Conclusions. Reducing patient FU appointments is crucial to the future of the NHS. Achieving this whilst simultaneously improving the quality of patient communication is achievable as this study has demonstrated. The potential scalability of this project to be applied other arthroscopic procedures is enormous. The study has demonstrated patients are comfortable with modern technology and feel it enhances their understanding whilst decreasing the need for routine post-op FU

Introduction: Regional anaesthesia is used recently more often in minor and intermediate orthopaedic procedures. This study evaluates regional anaesthesia in knee arthroscopy. Patients and Method: From September 2002 to February 2003, sixty three patients had knee arthroscopy by regional blockade, (mean age 28, 3 years). Thirty ml Ropivacaine 5% and 10 ml Lidocaine 2% were used to block sciatic and femoral nerve with nerve stimulator help. Results: They were realized 31 meniscectomies, 8 meniscal repairs, 6 primary ACL reconstructions, 2 ACL revisions, 5 chondroplasties, 6 lateral releases, 2 Fulkerson osteotomies, 4 plica removals, 2 adhesionlysis, 2 localized villonodular synovitis, one total synovectomy and one arthroscopic removal prepatellar bursa. There was no complication concerning the nerve blockade. Two of 8 ACL patients required general anesthesia and one had sedation during the procedure. Sedation also was necessary in three patients with lateral release and two meniscal repairs. The remaining 55 patients were tolerated the arthroscopic procedure without any additional help. All patients hospitalized less than 24 hours except patients with ACL reconstruction. They needed 1, 2 analgesic pills per person. The cost for the anesthetic procedure was 40 euros. Conclusion: Regional anesthesia has the advantage of avoiding the complications of general anesthesia, is of low cost and well bearable from the majority of patients. It offers prolonged postoperative analgesia and has no complications

Knee arthroscopy is the most commonly performed orthopaedic operation world wide. There is however little data on the incidence of DVT and consequently there is no consensus regarding the need for periopeartive thromboprophylaxia. Hoppener et al,2003 reported a high incidence of 11% DVT without the use of thromboprophylaxis. The aim of our study was to establish the incidence of venous thromboembolic complications in day case knee arthroscopy without any thromboprophylaxis. A retrospective review of 458 consecutive knee arthroscopies done in our unit between Feb 1998 to May 2007 were carried out. They were all day cases and did not receive any chemical thromboprophylaxis. All the case notes were carefully scrutinized for any readmissions for symptoms of venous thromboembolism(VTE). The clinical signs documented were pain, tenderness, swelling or redness of the legs, dyspnoea, chest pain and haemoptysis leg pains or redness following the surgery. There were 278 males and 180 females. The age group ranged from 15 to 88 years. The average age group was 57.7years. The primary out come of the study was the incidence of symptomatic and asymptomatic venous thromboembolic complications after the knee arthroscopy during the 2 week and 8 week followup period. Our study showed there were no cases of symptomatic deep vein thrombosis in any of the patients. The pooled overall estimate of the incidence of all VTE, without the use of thromboprophylaxis was 7.4%, symptomatic 2% and asymptomatic 5.4%. This is not in agreement with our study. The limitation of our study, it is a retrospective analysis and no investigative tools were used. We conclude that until more extensive studies have been performed, it seems justified to withhold thromboprophylaxis in patients undergoing uncomplicated knee arthroscopic procedures in a daycare setting

The increase in knee arthroscopy performed on an out-patient basis, along with the need for cost reduction and a safe and rapid patient discharge, has underlined the importance of adequate anaesthesia techniques. We designed this study to compare efficacy, efficiency and surgeon’s satisfaction of total intravenous anaesthesia with propofol and remifentanil with those of spinal or peripheral nerve blocks for outpatient knee arthroscopy. A total of 120 patients undergoing elective outpatient knee arthroscopy were randomly allocated to receive total intravenous anaesthesia with propofol and remifent-anil (n=40), combined sciatic-femoral nerve block (n=40) or spinal anaesthesia (n=40). Preparation times, surgeon’s satisfaction, discharge times and anaesthesia-related costs with the three anaesthesia techniques were analysed. Preparation time was shorter with general anaesthesia (13 min) than with spinal anaesthesia or sciatic-femoral block (15 min; p=0.006). Surgeon’s satisfaction was similar in the three groups. Furthermore, 17 patients receiving peripheral nerve block (42%) and 12 receiving spinal anaesthesia (30%) by-passed the post-anaesthesia care unit after surgery as compared with only two general anaesthesia patients (5%; p=0.01). Discharge from the post-anaesthesia care unit was more rapid after peripheral block; however, stay in the Day Surgery Unit was shorter after general anaesthesia than peripheral or spinal blocks (p=0.026). Urinary retention was reported in three spinal anaesthesia patients only (8%; p=0.03). Regional anaesthesia techniques reduce the rate of admission and the duration of stay in the post-anaesthesia care unit as compared with general anaesthesia. Peripheral rather than spinal nerve blocks should be preferred to minimise the risk of urinary retention