Trends in knee arthroscopy utilization: a gap in knowledge translation



To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30-day post-operative complications.


The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30-day post-operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses.


68,346 patients underwent knee arthroscopy, of which 47,446 (69.5%) represented partial meniscectomies. The annual procedural rate, as a proportion of all reported cases, increased significantly from 2006 (0.3%) to 2016 (1.6%; p < 0.001), along with a significant increase in average patient age (44.3 ± 15.5 to 48.4 ± 14.5; p < 0.001). Specifically focusing on the meniscectomy cohort, average patient age significantly increased from 47.9 ± 15.1 to 50.7 ± 13.5 (p = 0.001). The overall incidence of complications was 2.0% (n = 1333), with major complications in 0.9% (n = 639) and minor complications in 1.0% (n = 701). Common complications included a return to the operating room (0.5%), deep vein thrombosis/thrombophlebitis (0.4%), and superficial infection (0.2%). Operating time > 90 min, diabetes, steroid use, ASA class 2+, and dialysis-dependency were the predictors of overall complication rates.


Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. Given the high utilization, even low adverse event rates equate to substantial numbers of patients with minor and major complications. The NSQIP data show a gap in knowledge translation to clinical practice and highlight the need for improved clinical guidelines.

Level of evidence

Cohort study; Level III.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Abram SGF, Judge A, Beard DJ, Price AJ (2018) Adverse outcomes after arthroscopic partial meniscectomy: a study of 700,000 procedures in the national hospital episode statistics database for England. Lancet 392(10160):2194–2202.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Amin NH, Hussain W, Ryan J, Morrison S, Miniaci A, Jones MH (2017) Changes within clinical practice after a randomized controlled trial of knee arthroscopy for osteoarthritis. Orthop J Sport Med 5:1–6

    Article  Google Scholar 

  3. 3.

    Basques BA, Gardner EC, Varthi AG, Fu MC, Bohl DD, Golinvaux NS, Grauer JN (2015) Risk factors for short-term adverse events and readmission after arthroscopic meniscectomy: does age matter? Am J Sports Med 43:169–175

    Article  Google Scholar 

  4. 4.

    Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 25:335–346

    Article  Google Scholar 

  5. 5.

    Clair AJ, Inneh IA, Iorio R, Berend KR, Della Valle CJ, Healy WL, Pelligrini VD (2015) Can administrative data be used to analyze complications following total joint arthroplasty? J Arthroplasty 30:17–20

    Article  Google Scholar 

  6. 6.

    Cundall-Curry DJ, Lawrence JE, Fountain DM, Gooding CR (2016) Data errors in the national hip fracture database: a local validation study. Bone Joint J 98-B:1406–1409

    Article  Google Scholar 

  7. 7.

    Dhawan A, Mather RC, Karas V, Ellman MB, Young BB, Bach BR, Cole BJ (2014) An epidemiologic analysis of clinical practice guidelines for non-arthroplasty treatment of osteoarthritis of the knee. Arthroscopy 30:65–71

    Article  Google Scholar 

  8. 8.

    Elkousy H, Heaps B, Overturf S, Laughlin MS (2014) Financial impact of third-party reimbursement due to changes in the definition of ICD-9 arthroscopy codes 29880, 29881, and 29877. J Bone Joint Surg 96-A:1–7

    Google Scholar 

  9. 9.

    Ellis RJ, Liu JY, Ko CY (2018) Databases for surgical health services research: American college of surgeons national surgical quality improvement program. Surg (US) 164:173–175

    Article  Google Scholar 

  10. 10.

    Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT (2008) Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115

    CAS  Article  Google Scholar 

  11. 11.

    Faciszewski T, Jensen R, Berg RL (2003) Procedural coding of spinal surgeries (CPT-4 versus ICD-9-CM) and decisions regarding standards: a multicenter study. Spine 28:502–507 (Phila. Pa. 1976)

    PubMed  Google Scholar 

  12. 12.

    Feeley BT, Lau BC (2018) Biomechanics and clinical outcomes of partial meniscectomy. J Am Acad Orthop Surg 26:853–863

    Article  Google Scholar 

  13. 13.

    Felson DT (2006) Clinical practice. Osteoarthritis of the knee. N Engl J Med 354:841–848

    CAS  Article  Google Scholar 

  14. 14.

    Ghomrawi HMK, Marx RG, Pan TJ, Conti M, Lyman S (2018) The effect of negative randomized trials and surgeon volume on the rates of arthroscopy for patients with knee OA. Contemp Clin Trials Commun Elsevier 9:40–44

    Article  Google Scholar 

  15. 15.

    Holmes R, Moschetti W, Martin B, Tomek I, Finlayson S (2013) Effect of evidence and changes in reimbursement on the rate of arthroscopy for osteoarthritis. Am J Sports Med 41:1039–1043

    Article  Google Scholar 

  16. 16.

    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. Bone Joint J 93-B:1327–1333

    CAS  Google Scholar 

  17. 17.

    Jevsevar DS (2013) Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 21:571–576

    PubMed  Google Scholar 

  18. 18.

    Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA, Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP, Stuart MJ, Wright J, Wright RW, Losina E (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368:1675–1684

    CAS  Article  Google Scholar 

  19. 19.

    Katz JN, Jones MH (2016) Treatment of meniscal tear: the more we learn, the less we know. Ann Intern Med 164:503

    Article  Google Scholar 

  20. 20.

    Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, Feagan BG, Donner A, Griffin SH, D’Ascanio LM, Pope JE, Fowler PJ (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359:1097–1107

    CAS  Article  Google Scholar 

  21. 21.

    Loeser RF, Goldring SR, Scanzello CR, Goldring MB (2012) Osteoarthritis: a disease of the joint as an organ. Arthr Rheum 64:1697–1707

    Article  Google Scholar 

  22. 22.

    Marsh JD, Birmingham TB, Giffin JR, Isaranuwatchai W, Hoch JS, Feagan BG, Litchfield R, Willits K, Fowler P (2016) Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee. BMJ Open 6:1–10

    Article  Google Scholar 

  23. 23.

    Martin CT, Pugely AJ, Gao Y, Wolf BR (2013) Risk factors for thirty-day morbidity and mortality following knee arthroscopy. J Bone Jt Surg Am 95:1–10

    Article  Google Scholar 

  24. 24.

    Matsubara H, Okazaki K, Takayama Y, Osaki K, Matsuo Y, Honda H, Iwamoto Y (2015) Detection of early cartilage deterioration associated with meniscal tear using T1ρ mapping magnetic resonance imaging. BMC Musculoskelet Disord 16:22

    Article  Google Scholar 

  25. 25.

    Moseley J, O’Malley K, Petersen N, Menke T, Brody B (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. NEJM 347:1081–1090

    Article  Google Scholar 

  26. 26.

    Sanders TL, Pareek A, Desai VS, Hewett TE, Levy BA, Stuart MJ, Dahm DL, Krych AJ (2018) Low accuracy of diagnostic codes to identify anterior cruciate ligament tear in orthopaedic database research. Am J Sports Med 46:2894–2898

    Article  Google Scholar 

  27. 27.

    Siemieniuk RAC, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, Buchbinder R, Englund M, Lytvyn L, Quinlan C, Helsingen L, Knutsen G, Olsen NR, Macdonald H, Hailey L, Wilson HM, Lydiatt A, Kristiansen A (2018) Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. Br J Sports Med 52:313.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Ikonen A, Järvelä T, Järvinen TAH, Kanto K, Karhunen J, Knifsund J, Kröger H, Kääriäinen T, Lehtinen J, Nyrhinen J, Paloneva J, Päiväniemi O, Raivio M, Sahlman J, Sarvilinna R, Tukiainen S, Välimäki VV, Äärimaa V, Toivonen P, Järvinen TLN (2018) Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial. Ann Rheum Dis 77:188–195

    Article  Google Scholar 

  29. 29.

    Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TLN (2013) Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 369:2515–2524

    CAS  Article  Google Scholar 

  30. 30.

    Westermann RW, Pugely AJ, Ries Z, Amendola A, Martin CT, Gao Y, Wolf BR (2015) Causes and predictors of 30-day readmission after shoulder and knee arthroscopy: an analysis of 15,167 cases. Arthroscopy 31:1035–1040

    Article  Google Scholar 

Download references


No sources of funding for this study. No authors report relevant financial disclosures.

Author information



Corresponding author

Correspondence to Ryan M. Degen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This study utilized de-identified publicly available data and therefore formal consent is not required.


The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Degen, R.M., Lebedeva, Y., Birmingham, T.B. et al. Trends in knee arthroscopy utilization: a gap in knowledge translation. Knee Surg Sports Traumatol Arthrosc 28, 439–447 (2020).

Download citation


  • Knee arthroscopy
  • Trends
  • Complications
  • Utilization
  • Knowledge translation