Arthroscopic surgery of the knee in local anaesthesia

Summary

Arthroscopy of the knee joint was performed in 356 consecutive outpatients in local anaesthesia and without premedication. A continuous pressure-irrigation system was used with 0.2% lidocaine chloride solution in the irrigation fluid, following administration of 5–7 ml prilocaine with epinephrine in each portal. All patients had clinical symptoms of internal derangement of the knee, such as meniscal, cruciate ligament injury or osteoarthritis. Associated intra-articular pathology was registered. Intra-articular surgery was performed in 228 cases. This included partial or subtotal meniscectomy in 207 cases and meniscus suture in 3 cases. In 18 of 228 cases (8%) the operative procedure had to be terminated due to patient discomfort. Of the meniscal injuries 84% were medial and 16% lateral. The age distribution of the medial meniscus tears was as follows: bucket handles 33 ± 9 years; flap tears 42 ± 10 years and degenerative tears 53 ± 10 years. For the lateral meniscus the age distribution was: bucket handles 34 ± 9 years, cleavage and radiating tears 37.5 ± 12 years, flap tears 29 ± 7 years, peripheral tears 32 ± 9 years and degenerative tears 48 ± 11 years. Osteoarthritis was observed in 52% of all medial degenerative tears, whereas a low frequency was found in the remaining tears. The majority of patients tolerated the procedure well. In summary, 64% of the consecutive arthroscopies were operative, including 3 meniscal sutures. Only 8% of these procedures had to be abandoned due to patient discomfort. Thus, arthroscopic surgery in local anaesthesia with no premedication is an efficient and well-tolerated method in outpatient practice.