Summary

Nearly 1 in 20 pediatric and adolescent knee arthroscopies resulted in a Grade III complication, with nearly 50% attributable to stiffness.

Abstract

Background

Sport-related injuries among youth are increasing in incidence and severity. While injury recognition and treatment frequency has increased, data on perioperative complications following pediatric and adolescent knee arthroscopy remain limited. The purpose of this study was to report the incidence of Grade III complications (unplanned reoperation or admission) and to identify the odds of these complications by associated risk factors.

Methods

Consecutive knee arthroscopic procedures (patients <=19 years old), with a minimum of 8-months follow-up, were queried from a multi-center quality improvement registry (28 contributing surgeons). Perioperative variables, intraoperative techniques, and post-operative graded complications (Modified Clavien-Dindo), were prospectively entered into an electronic data system (WDS, ABOS; Chicago, IL). For analysis, complications exclusive to certain types of procedures (ligament graft failure or meniscal repair failure) were excluded to allow comparison of generalizable complications across all procedures. Descriptive statistics (frequencies and percentages and means and standard deviations) were estimated by associated risk factors for Grade III complications overall and by type. Complication odds ratios were estimated with multilevel logistic regression analyses with restricted maximum likelihood.

Results

A total of 6,139 patients were eligible from the registry, including 2,261 (36.8%) anterior cruciate ligament reconstructions (ACL), 2,115 (34.5%) ACL+meniscus repairs, 747 (12.2%) isolated meniscus repairs, 419 (6.8%) discoid meniscus treatment, 255(4.2%) tibial spine repairs, and the remaining some other combination of the above. The majority of cases occurred in surgery centers (52.9%), among adolescents aged 13-19 years (83.9%), males (54.4%), and in those with a healthy BMI (5th to <85th percentile), (52.7%). Overall, 4.5% (276 cases) (84.1% reoperation; 2.2% readmission) of cases resulted in a Grade III complication (mean follow-up of 28 months, range: 8-56 months). Within Grade III complications, 44.9% (124/276) were attributable to post-operative stiffness. Greater years of surgeon experience was protective against a Grade III complication 0.98 (95% CI=0.96-0.99), however when a second attending assisted with a case, this was associated with 3.96 (95% CI=1.51-10.35) times greater odds of a Grade III complication relative to no assistant present. As compared to males, females were associated with 1.95 (95% CI=1.51-2.51) times greater odds of a Grade III complication. Conversely, those who were classified as obese had 0.70 (95% CI=0.50-0.97) times the odds of a Grade III complication compared with those classified as having a normal BMI.

Conclusions

Nearly 1 in 20 pediatric and adolescent knee arthroscopies resulted in a Grade III complication, with nearly 50% attributable to stiffness. Infection related readmission or surgery rates were low. Results from the SCORE Registry suggest that reduction of early reoperation or readmission following knee arthroscopy may be best focused on techniques to reduce the occurrence of knee stiffness and identify non-operative modalities to prevent the need for reoperation when this complication does occur.