What are the prevalence and risk factors for repeat ipsilateral knee arthroscopy?

  • Omar A. BeheryEmail author
  • Kelly I. Suchman
  • Albit R. Paoli
  • Tyler A. Luthringer
  • Kirk A. Campbell
  • Joseph A. Bosco



The number of arthroscopic knee surgeries performed annually has increased over the last decade. It remains unclear what proportion of individuals undergoing knee arthroscopy is at risk for subsequent ipsilateral procedures. Better knowledge of risk factors and the incidence of reoperative ipsilateral arthroscopy are important in setting expectations and counselling patients on treatment options. The aim of this study is to determine the incidence of repeat ipsilateral knee arthroscopy, and the risk factors associated with subsequent surgery over long-term follow-up.


The New York Statewide Planning and Research Cooperative Systems outpatient database was reviewed from 2003 to 2016 to identify patients who underwent elective, primary knee arthroscopy for one of the following diagnosis-related categories of procedures: Group 1: cartilage repair and transfer; Group 2: osteochondritis dissecans (OCD) lesions; Group 3: meniscal repair, debridement, chondroplasty, and synovectomy; Group 4: multiple different procedures. Subjects were followed for 10 years to determine the odds of subsequent ipsilateral knee arthroscopy. Risk factors including the group of arthroscopic surgery, age group, gender, race, insurance type, surgeon volume, and comorbidities were analysed to identify factors predicting subsequent surgery.


A total of 765,144 patients who underwent knee arthroscopy between 2003 and 2016, were identified. The majority (751,873) underwent meniscus-related arthroscopy. The proportion of patients undergoing subsequent ipsilateral knee arthroscopy was 2.1% at 1-year, 5.5% at 5 years, and 6.7% at 10 years of follow-up. Among patients who underwent subsequent arthroscopic surgery at 1-, 5-, and 10-year follow-up, there was a greater proportion of patients with worker’s compensation insurance (p < 0.001), index operations performed by very high volume surgeons (p < 0.001), and cartilage restoration index procedures (p < 0.001), compared with those who never underwent repeat ipsilateral surgery.


Understanding the incidence of subsequent knee arthroscopy after index procedure in different age groups and the patterns over 10 years of follow-up is important in counselling patients and setting future expectations. The majority of subsequent surgeries occur within the first 5 years after index surgery, and subjects tend to have higher odds of ipsilateral reoperation for up to 10 years if they have worker’s compensation insurance, or if their index surgery was performed by a very high volume surgeon, or was a cartilage restoration procedure.

Level of evidence



Knee arthroscopy Cartilage repair Osteochondritis dissecans Meniscal repair Subsequent knee arthroscopy 


Author contributions

OB reviewed the analysed data, all the relevant literature, statistical results, drafted the manuscript and made any necessary edits as part of the review process. KS assisted with gathering the literature review for the paper and formatting the references. AP was involved with SPARCS dataset management and statistical analysis for hypothesis testing. TL contributed to manuscript writing as well as editing process. KC reviewed the manuscript drafts and contributed to the editing and review process. JB senior author for this study, who developed the research question, hypotheses and guided the editing/review process.


No internal or external funding sources were used to conduct this study.

Compliance with ethical standards

Conflict of interest

There are no relevant disclosures, relationships, conditions or circumstances to report that may represent potential conflict of interest in this study.

Ethical approval

This research represents an analysis of the large and public Statewide Planning and Research Cooperative System (SPARCS) database, which contains no patient identifiers and is exempt from the institutional review board (IRB) process.

Supplementary material

167_2019_5348_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 11 KB)


  1. 1.
    Boyd JA, Gradisar IM (2016) Total knee arthroplasty after knee arthroscopy in patients older than 50 years. Orthopedics 39:e1041–e1044CrossRefGoogle Scholar
  2. 2.
    Bursac Z, Gauss CH, Williams DK, Hosmer DW (2008) Purposeful selection of variables in logistic regression. Source Code Biol Med 3:17CrossRefGoogle Scholar
  3. 3.
    Cullen KA, Hall MJ, Golosinskiy A (2009) Ambulatory surgery in the United States, 2006. Natl Health Stat Rep (11):1–25Google Scholar
  4. 4.
    Doral MN, Bilge O, Huri G, Turhan E, Verdonk R (2018) Modern treatment of meniscal tears. EFORT Open Rev 3:260–268CrossRefGoogle Scholar
  5. 5.
    Frank RM, Lee S, Levy D, Poland S, Smith M, Scalise N et al (2017) Osteochondral allograft transplantation of the knee: analysis of failures at 5 years. Am J Sports Med 45:864–874CrossRefGoogle Scholar
  6. 6.
    Frank RM, McCormick F, Rosas S, Amoo-Achampong K, Erickson B, Bach BR Jr et al (2018) Reoperation rates after cartilage restoration procedures in the knee: analysis of a large US commercial database. Am J Orthop (Belle Mead NJ) 47:1–15Google Scholar
  7. 7.
    Gundle KR, McGlaston TJ, Ramappa AJ (2010) Effect of insurance status on the rate of surgery following a meniscal tear. J Bone Joint Surg Am 92:2452–2456CrossRefGoogle Scholar
  8. 8.
    Hawker G, Guan J, Judge A, Dieppe P (2008) Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 90:2337–2345CrossRefGoogle Scholar
  9. 9.
    Jameson SS, Dowen D, James P, Serrano-Pedraza I, Reed MR, Deehan DJ (2011) The burden of arthroscopy of the knee: a contemporary analysis of data from the English NHS. J Bone Joint Surg Br 93:1327–1333CrossRefGoogle Scholar
  10. 10.
    Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M (2014) Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 186:1057–1064CrossRefGoogle Scholar
  11. 11.
    Lubowitz JH, Appleby D (2011) Cost-effectiveness analysis of the most common orthopaedic surgery procedures: knee arthroscopy and knee anterior cruciate ligament reconstruction. Arthroscopy 27:1317–1322CrossRefGoogle Scholar
  12. 12.
    Mahure SA, Mollon B, Shamah SD, Zuckerman JD, Kwon YW, Rokito AS (2016) The incidence of subsequent surgery after outpatient arthroscopic rotator cuff repair. Arthroscopy 32:1531–1541CrossRefGoogle Scholar
  13. 13.
    McCormick F, Harris JD, Abrams GD, Hussey KE, Wilson H, Frank R et al (2014) Survival and reoperation rates after meniscal allograft transplantation: analysis of failures for 172 consecutive transplants at a minimum 2-year follow-up. Am J Sports Med 42:892–897CrossRefGoogle Scholar
  14. 14.
    Mickey RM, Greenland S (1989) The impact of confounder selection criteria on effect estimation. Am J Epidemiol 129:125–137CrossRefGoogle Scholar
  15. 15.
    Montgomery SR, Foster BD, Ngo SS, Terrell RD, Wang JC, Petrigliano FA et al (2014) Trends in the surgical treatment of articular cartilage defects of the knee in the United States. Knee Surg Sports Traumatol Arthrosc 22:2070–2075CrossRefGoogle Scholar
  16. 16.
    Patel AA, Singh K, Nunley RM, Minhas SV (2016) Administrative databases in orthopaedic research: pearls and pitfalls of big data. J Am Acad Orthop Surg 24:172–179CrossRefGoogle Scholar
  17. 17.
    Salzler MJ, Lin A, Miller CD, Herold S, Irrgang JJ, Harner CD (2014) Complications after arthroscopic knee surgery. Am J Sports Med 42:292–296CrossRefGoogle Scholar
  18. 18.
    Suchman KI, Behery OA, Mai DH, Anil U, Bosco JA (2018) The demographic and geographic trends of meniscal procedures in New York State: an analysis of 649,470 patients over 13 years. J Bone Joint Surg Am 100:1581–1588CrossRefGoogle Scholar
  19. 19.
    Wylie JD, Hartley MK, Kapron AL, Aoki SK, Maak TG (2016) Failures and reoperations after matrix-assisted cartilage repair of the knee: a systematic review. Arthroscopy 32:386–392CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Division of Sports Medicine, Department of Orthopedic SurgeryNYU Langone Orthopedic HospitalNew YorkUSA
  2. 2.Icahn School of Medicine at Mount SinaiNew YorkUSA

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