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Knee arthroscopy

122 citationsUpdated Sep 2026

Overview

Knee arthroscopy is a valuable treatment for patients with radiological signs of severe osteoarthritis [4], though its utilization and average patient age continue to increase despite negative trials and new clinical practice guidelines [9]. Before establishing the indication, it is mandatory to implement an algorithm of diagnostic and conservative therapeutic procedures [6]. The procedure may be recommended when first-line treatment, including exercise therapy for 3 months, does not relieve patient symptoms, considering the short-term benefit and no long-term harm from knee arthroscopic surgery [5]. Most patients had no knee-related activity restriction 4 weeks after arthroscopy [2]. In pediatric patients, knee arthroscopy is useful in providing a definitive diagnosis for knee pain, while preoperative diagnosis based on clinical and imaging evaluations should be interpreted with caution [15].

The absolute risks of complications associated with knee arthroscopy remain small at about 1% [1]. Major complications following knee arthroscopy in children and adolescents are relatively low at 1.4% [7], and while major complications are rare, minor complications are more common [16]. A 10.2% failure rate 1 year after knee arthroscopy may be a reasonable benchmark against which performance in patients older than 65 years can be measured [37]. The benefit of knee arthroscopic surgery, seen at 1 year in middle-aged patients with meniscal symptoms, was diminished at 3 years and was no longer statistically significant [19]. Patient and/or surgeon preference may play a large role in the decision to perform an arthroscopy without a valid indication [41].

MRI scans are not routinely necessary as an indication for knee arthroscopy, as clinical examination and plain radiograph are sufficient [26]. Routine pathological examination of surgical specimens had limited cost-effectiveness because of the low prevalence of findings that altered patient management [10]. Routine medical thromboprophylaxis following knee arthroscopy has low utility because the overall rate of symptomatic venous thromboembolism is relatively low [49]. The choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months [22]. Scores on a knee arthroscopy exercise were significantly improved after the programme, with the greatest improvements observed in operative time and motion sparing among less experienced surgeons [29]. The decline in knee arthroscopy utilization for degenerative meniscus tears is driven by changes in healthcare economics, reimbursement rates, and growing evidence questioning the efficacy of the procedure [70].

Anatomy & Pathophysiology

Osseous Anatomy

The knee joint comprises the distal femur, proximal tibia, and patella [55]. The medial femoral condyle is larger and projects farther posteriorly and distally than the lateral condyle [83]. Conversely, the lateral femoral condyle projects farther anteriorly and is wider in the medial-lateral direction [83]. The lateral condyle’s broader mean anterior-posterior dimension allows internal rotation of the distal femur with knee extension [87]. The sulcus terminalis is a small ridge on the lateral femoral condyle just distal to the intercondylar notch that separates the patellofemoral and tibiofemoral articular surfaces [83]. This transverse ridge extends from the oblique facets of the femoral trochlea and is deeper on the lateral condyle than on the medial condyle [87]. The trochlear groove separates the femoral condyles anteriorly and constitutes the patellofemoral articulation [83], with the lateral trochlear facet resisting lateral subluxation of the patella [87]. The intercondylar notch is of variable width and serves as the attachment site for the cruciate ligaments [83].

The tibial articular surface slopes 7° to 10° in the sagittal plane [83]. The posterior slope of the tibia averages 10.7° in the medial plateau and 7.2° in the lateral plateau [87]. The medial tibial plateau is larger than the lateral plateau and is concave in both frontal and sagittal planes [83]. The lateral tibial plateau is smaller, more circular, concave in the frontal plane, and convex in the sagittal plane [83]. The plateaus are separated by the intercondylar eminence and its medial and lateral spinous processes [83]. The tibial tuberosity, the attachment site for the patellar tendon, is typically midline anteriorly but may be slightly lateral [83]. Gerdy’s tubercle, the insertion site of the iliotibial band, is located 2 to 3 cm lateral to the tibial tubercle on the proximal tibia [83]. The proximal fibula articulates with a facet of the lateral tibial cortex and is not part of the knee articulation [83]. The fibular head is located a mean of 1.5 cm distal to the joint line, with a range of 6 to 32 mm below the joint line [87].

The patella is the largest sesamoid bone in the body, averaging 2.5 cm in thickness [83]. It possesses the thickest articular surface in the body, approximately 5 mm in the midportion and 2 mm on the sides [83]. The patellar articular surface contains a vertical central ridge separating the broader lateral facet from the medial facet, along with a smaller, more medial odd facet [83]. The odd facet is a small facet on the distal medial patella that articulates in deep flexion of the knee [87]. In the Wiberg classification: * Type I: Medial and lateral facets are equal in size [87]. * Type II: The most common type, featuring a medial facet that is smaller and one half the size of the lateral facet [87]. * Type III: The medial facet is so far medial that the central ridge is barely noticeable [87].

Ligamentous Anatomy

The anterior cruciate ligament (ACL) travels from the medial border of the lateral femoral condyle to its insertion site anterolateral to the medial tibial spine [55]. It prevents anterior translation and rotation of the tibia on the femur [55]. The ACL is composed of 90% type I collagen and 10% type III collagen [83, 84]. Its mean length is 33 mm and mean midsubstance width is 11 mm [83, 87]. The femoral attachment is a semicircular area (20 mm long and 10 mm wide) on the posteromedial aspect of the lateral femoral condyle [83, 87]. This attachment is divided by the bifurcate ridge and bordered by the intercondylar ridge [84]. The tibial attachment is a broad, irregular, oval-shaped area (30 mm long and 10 mm wide) slightly medial and anterior to the midline, between the medial and lateral tibial spinous processes [83]. Specifically, it lies immediately medial to the attachment of the anterior horn of the lateral meniscus and posterior to the tubercle of the anterior horn of the medial meniscus [84]. The ACL has two bundles named according to their tibial insertions: anteromedial and posterolateral [84]. The anteromedial bundle originates proximal to the bifurcate ridge, is tight in flexion, and resists anterior tibial translation in knee flexion [84, 87]. The posterolateral bundle originates distal to the bifurcate ridge, is tight in extension, and resists rotatory loads in knee extension [84, 87]. The posterolateral bundle is responsible for preventing the pivot-shift phenomenon and stabilizes against anterior translation with 30° of knee flexion [87]. The anteromedial bundle increases anterior tibial translation at 60° and 90° of knee flexion [87]. The primary function of the ACL is to resist anterior translation of the tibia relative to the femur, with a secondary function of resisting varus/valgus stresses in full extension [91].

The posterior cruciate ligament (PCL) runs from the lateral aspect of the medial femoral condyle to the posterior aspect of the tibia, just below the joint line [55]. It prevents posterior subluxation of the tibia on the femur [55]. The PCL is the largest intra-articular ligament, with an average length of 38 mm and a mean diameter at the midpoint of 13 mm [94, 87]. Its cross-sectional area is approximately 120% to 150% greater than that of the ACL [94]. The PCL is most narrow in its midsubstance, fanning out at both the femoral origin and tibial insertion [94]. The femoral attachment is a broad, crescent-shaped or semicircular area on the anterolateral aspect of the medial femoral condyle, adjacent to the articular surface [94, 87]. This footprint has a mean length of 30 mm and mean width of 5 mm [87]. In the coronal plane, the PCL femoral attachment is typically between 12 and 4 o'clock in the right knee, and between 12 and 8 o'clock in the left knee [94]. The insertion of the two PCL bundles is separated by a medial bifurcate ridge [94]. The PCL has two distinct bundles defined by their insertion on the femur: an anterolateral (AL) bundle and a posteromedial (PM) bundle [94]. The AL bundle is larger, comprising 85% of the PCL's cross-sectional area, and is stronger and stiffer than the PM bundle [94, 87]. The AL bundle is tight in knee flexion, while the PM bundle is tight in knee extension [87]. The PCL inserts onto a midline depression on the tibia, 10 to 15 mm below the level of the medial and lateral tibial plateaus [94, 87]. The tibial fossa is trapezoidal in shape [94]. The AL bundle occupies the superolateral aspect of the tibial footprint, with the PM bundle occupying the inferomedial aspect of the intercondylar fossa [94]. The PCL resists posterior tibial translation at all degrees of knee flexion, tibial internal and external rotation beyond 90 degrees of knee flexion, and varus translation [84]. Its primary function is to resist posterior translation of the tibia relative to the femur, with a secondary function of resisting tibial external rotation [91].

The medial collateral ligament (MCL) has superficial and deep portions which stabilize the knee to valgus stresses [55]. The MCL originates on the femoral sulcus approximately 3.2 cm proximal and 4.8 cm posterior to the articular surface of the femur at the knee [87]. The adductor tubercle is a prominence on the medial condyle proximal to the MCL origin and is the site of insertion of the adductor magnus muscle [87]. The superficial MCL proximal division resists valgus tibial translation, while the distal division resists tibial external rotation in knee extension [84]. The deep MCL resists valgus translation [84]. The posteromedial corner resists valgus stress [91]. The posterior oblique ligament resists tibial internal rotation, especially in knee extension [84].

The lateral collateral ligament (LCL), or fibular collateral ligament, runs from the lateral femoral condyle to the head of the fibula and is the main stabilizer against varus stress [55]. It is part of the posterolateral “complex” or “corner” of the knee that also resists external rotation [55]. The LCL resists varus tibial translation [84]. The posterolateral corner resists posterior translation, external rotation, and varus angulation of the tibia [91]. The popliteofibular ligament, present in 90% of knees, runs from the tendon of the popliteus muscle to the styloid on the posterior fibular head [55]. The popliteus tendon and the popliteofibular ligament both resist tibial external rotation, especially in knee flexion [84]. The oblique popliteal ligament resists knee hyperextension [84].

Meniscal Anatomy

The menisci are C-shaped fibrocartilaginous disks that provide shock absorption, allow for increased congruency between joint surfaces, enhance joint stability, and aid in distribution of synovial fluid [55]. They provide a concave surface with which the convex femoral condyles can articulate [55]. Without the menisci, the convex femoral condyles articulate with the relatively flat tibial plateaus, decreasing surface area of contact and increasing pressure on the articular cartilage [55]. The medial meniscus is firmly attached to the joint capsule along its entire peripheral edge [55]. The lateral meniscus is attached to the anterior and posterior capsule, but there is a region posterolaterally where it is not firmly attached [55]. The medial meniscus has less mobility than the lateral meniscus and is more susceptible to tearing when trapped between the femoral condyle and tibial plateau [55]. The lateral meniscus is larger than the medial meniscus [55].

Vascular Anatomy

The blood supply to the knee is formed from an anastomosis around the knee derived from the descending geniculate artery, medial and lateral superior geniculate arteries, medial and lateral inferior geniculate arteries, middle geniculate artery, and anterior tibial recurrent arteries [83]. The middle geniculate artery is the primary blood supply to both the ACL and the PCL [83, 87]. The inferior geniculate arteries pass deep to their respective collateral ligaments [83]. The blood supply of the patella is derived from the geniculate artery complex with some contribution from the anterior tibial recurrent artery and primarily exists in the middle to inferior portions of the patella [83]. The vascular supply of the menisci is derived from the geniculate arteries, which penetrate into 20% to 30% of the peripheral medial meniscus and 10% to 25% of the peripheral lateral meniscus [87]. The popliteal artery is near the PCL, and the distance increases with knee flexion [87]. The popliteus artery travels through the adductor hiatus, where it is relatively immobile, and distally through the fibrous arch deep to the soleus muscle [91].

Neural Anatomy

The knee is innervated by branches of the femoral nerve (L2, L3, L4), obturator nerve (L2, L3, L4), and sciatic nerve (L4, L5, S1, S2) [83]. The largest nerve providing innervation of the intra-articular knee is the posterior articular branch of the tibial nerve [83]. This branch supplies the infrapatellar fat pad, the synovial covering over the cruciate ligaments, and the periphery of the meniscus [83]. It also provides innervation to both the ACL and the PCL [87]. Nerves to the cruciate ligaments contain vasomotor and pain fibers as well as mechanoreceptors that may be involved in proprioception [83]. The infrapatellar branch of the saphenous nerve arises proximal to the knee joint medially and crosses distal to the patella to innervate the skin over the region of the anterior knee and proximal tibia [83]. The common peroneal nerve travels along the posterior edge of the biceps femoris and continues distally around the fibular neck [91]. The tibial nerve, after branching from the sciatic nerve, courses distally through the center of the popliteus fossa [91].

Classification

ROCK OCD: The ROCK OCD Knee arthroscopy classification system demonstrates high reliability for classifying osteochondral defects [111].

ICRS: The International Cartilage Repair Society (ICRS) grading system classifies cartilage defects from grade 0 (normal) to grade 4 (severe cartilage lesions) [168].

Outerbridge: The Outerbridge classification is used to grade articular cartilage lesions arthroscopically, with grades 0 and I recorded as normal [48].

BAKSSS: The Basic Arthroscopic Knee Skill Scoring System (BAKSSS) is a validated objective assessment tool for evaluating knee arthroscopy skills [186]. It consists of a task-specific checklist and a global rating scale [186]. The task-specific checklist records the completion of procedure components, including relevant landmarks in diagnostic knee arthroscopy and the quality of partial meniscectomy [186]. The global rating scale is a 50-point scale consisting of a 1- to 5-point Likert-type scale separated into 10 categories evaluating different qualities of the procedure [186].

Other Considerations: Knee arthroscopy provides a definitive diagnosis in pediatric patients with knee pain [15]. Consequently, preoperative diagnosis based on clinical and imaging evaluations in pediatric patients should be interpreted with caution [15]. A pilot study tool was able to distinguish among novice, experienced, and expert levels in performing diagnostic arthroscopy [161].

Clinical Presentation

History and Physical Examination

A detailed history for knee pain must include onset, quality, duration, tempo, location of symptoms, modifying factors, ability to bear weight, and history of trauma [114]. Patients indicated for knee arthroscopy typically present with complaints of knee swelling, locking, catching, or sudden giving way [46]. Catching or locking, instability in the coronal and/or sagittal plane, or an effusion can signal the presence of a mechanical pathology warranting surgical treatment [140].

Physical examination of the knee includes inspection, palpation, gait assessment, range of motion testing, stability testing, neurovascular assessment, hip examination, and special tests for specific pathologies [114]. Inspection reveals skin abnormalities, evidence of trauma, malalignment, and swelling [114]. Palpation focuses on points of tenderness to identify focal pathologies such as joint line tenderness, patellar tendon tenderness, or pes anserine bursa tenderness [114]. Palpation of peripatellar tissue can reveal the presence of effusion and/or synovitis [114]. In patients presenting for arthroscopy, physical examination often reveals an effusion, joint line tenderness, and positive meniscal signs including pain or palpable click with McMurray’s test, pain with Thessaly’s test or Apley’s test, or pain while performing a deep squat [46].

Knee alignment (varus, valgus, or neutral) should be assessed in both supine and standing positions, as weight-bearing may dynamically change alignment [114]. Range of motion testing distinguishes between active and passive motion, noting flexion contractures, hyperextension, and blocks to motion that may be pain-related or mechanical [114]. Hip range of motion should be examined to identify referred pain from intra-articular hip pathology [114]. The lumbar spine and hips should be examined because pathology in one of these locations can present as referred pain to the knee [140]. Lower extremities should be examined for evidence of muscular atrophy or weakness, with particular attention to hip abductor and quadriceps strength [140]. Distal sensation and vascular perfusion (peripheral pulses) should be assessed in all patients, and any abnormalities should be documented [140]. For symptomatic osteoarthritis, the patient’s gait, lower body alignment, range of motion, and ligamentous stability should be assessed and documented [140]. Preoperative diagnosis based on clinical and imaging evaluations in pediatric patients with knee pain should be interpreted with caution [15].

Basic varus and valgus stability testing is performed at 0° and 30° of flexion, with testing at 30° best isolating the MCL and LCL [114]. The Lachman test involves flexing the knee to 30°, holding the femur firmly, and translating the tibia anteriorly on the femur to assess ACL competence [114]. The posterior drawer test involves flexing the knee to 90° with the patient supine, stabilizing the distal tibia, and translating the tibia posteriorly on the femur to assess PCL competence [114]. The McMurray test for a medial meniscus tear involves flexing the knee, externally rotating the tibia, extending the knee, and applying pressure to the medial joint line, with pain or a click indicating a positive result [114]. The McMurray test for a lateral meniscus tear involves flexing the knee, internally rotating the tibia, extending the knee, and applying pressure to the lateral joint line, with pain or a click indicating a positive result [114]. The dial test for posterolateral corner deficiency involves externally rotating both tibiae with the patient prone and knee flexed to 30°, with a greater than 10° difference from the contralateral side indicating a positive result [114].

Imaging

Plain radiographs are appropriate initial imaging studies for most knee conditions because they allow assessment of traumatic injury, arthritis, patellofemoral alignment, osteochondral injury, bone neoplasm, and surgical implants [39]. Orthogonal views for knee radiography should include at least two perpendicular views: AP and lateral [39]. Weight-bearing AP (extension) views are used to assess cartilage loss from the distal femur and tibial plateau [39]. Weight-bearing PA (Rosenberg; flexion) views are used to assess cartilage loss from the posterior femur and tibial plateau [39]. Patellofemoral views are used to assess patellofemoral alignment, patellar and trochlear morphology, osteochondral injury, and patellofemoral arthritis [39]. A notch view is used to assess posterior femoral cartilage, notch width, and osteophytes [39]. Radiography may identify subchondral sclerosis, joint space narrowing, subchondral cysts, osteophytes, and joint subluxation in osteoarthritis [39].

Baseline weight-bearing radiographs of the knee should be obtained in all patients with symptomatic osteoarthritis [140]. A standing PA view obtained with the patient’s knee in 45° of flexion often is preferred over the standard standing AP view for evaluating osteoarthritis [140]. The 45° flexion PA view allows better evaluation of the posterior femoral condyles and earlier detection of subtle joint-space loss than the AP view [140]. Additional radiographs for knee osteoarthritis should include a lateral view of the affected side and a Merchant or sunrise view of the patellofemoral joint [140]. Radiographs obtained during the initial examination of a ligament injury can rule out physeal or other fractures about the knee [134]. Radiographs may demonstrate abnormalities of alignment, such as an anteriorly translated tibia seen on a lateral view, that make diagnosis of a ligament injury possible [134].

MRI may identify the degree of articular cartilage injury, the presence of associated bone marrow edema, and the location of the injury [39]. MRI patterns of meniscal injury can be identified by location, pattern (horizontal, longitudinal, radial, complex), and displacement [39]. MRI is useful for confirming a suspected diagnosis or when an adequate physical examination is not possible in ligament injuries [134]. Data suggests that MRI scans are not routinely necessary as an indication for knee arthroscopy, as clinical examination and plain radiograph are sufficient [26].

Arthroscopic Findings and Diagnostic Utility

The entirety of the small knee is assessable via standard diagnostic arthroscopy when a 2.7mm arthroscope is utilized, suggesting intraarticular pathology can be reliably identified [23]. Use of the flounce sign in routine knee arthroscopy can be helpful, particularly during screening procedure and in exploring tears which are usually not seen easily through routine portals [21]. If the "crevice sign" is observed during an arthroscopic procedure, surgeons should ensure they probe the medial meniscus carefully and treat accordingly [65]. ACL rupture and symptomatic cartilage lesions exhibit distinct synovial fluid inflammatory profiles at the time of arthroscopic knee surgery [66]. Synovial fluid levels of MCP-1 and IL-6 are strong predictors of severe cartilage lesions independent of other injuries, and predict worse clinical outcomes at 1 year after knee arthroscopy [126].

Arthroscopy should be considered a diagnostic aid used in conjunction with a good history, complete physical examination, and appropriate radiographs, serving as an adjunct to, not a replacement for, a thorough clinical evaluation [155]. With increased proficiency in examination and more accurate adjuvant tests including MRI, simple "diagnostic arthroscopy" is rarely performed [155].

Investigations

Plain radiography: Plain radiographs serve as the appropriate initial imaging study for most knee conditions, allowing assessment of traumatic injury, arthritis, patellofemoral alignment, osteochondral injury, bone neoplasm, and surgical implants [39]. Weight-bearing views assess cartilage loss from the distal femur and tibial plateau via AP extension and from the posterior femur and tibial plateau via PA flexion [39]. Radiographs remain the standard for initial evaluation of knee arthritis, including weight-bearing AP and lateral views, a 45-degree flexion view, a sunrise view, extension and flexion lateral views, and a standing full-length AP radiograph [100]. Supine AP knee radiographs do not adequately estimate the joint space width needed to estimate the degree of osteoarthritis progression [103]. To address inaccuracies in plain frontal radiographs, a 45° standing flexion view was introduced to better evaluate the joint space [103]. The fixed flexion view (FFV) has been introduced with improved reproducibility and good evaluation of the joint space [103]. Goniometer readings of long limb alignment or measured on a fixed flexion view correlate well with the angle measured on long limb radiographs, providing an alternative if long limb radiographs are not available [103]. Radiographic evaluations are essential when diagnosing an osteochondritis dissecans (OCD) lesion of the knee, though important aspects of the lesion may be better seen with MRI [102].

MRI: MRI may identify the presence of edema, intra-articular fluid, disruption of ligament fibers, and an atypical ligament contour to suggest cruciate ligament injury [39]. It can identify patterns of meniscal injury by location, pattern, and displacement [39]. MRI may be used to assess the continuity of the quadriceps or patellar tendon [39] and to assess neurovascular structures, including the margin of resection for a neoplasm, identification of vascular malformation, or definition of nerve and vessel location relative to popliteal cysts [39]. MRI is the most useful study for differentiating osteonecrosis from other conditions such as osteochondritis dissecans, transient osteoporosis, bone bruises, or occult fractures [106]. A serpentine lesion within a well-demarcated border is a specific finding on MRI for osteonecrosis [106]. In the arthritic patient population, MRI is considered grossly overused and is not indicated if the joint space is significantly narrowed on radiograph [100]. However, MRI is used when osteonecrosis is suspected in the context of knee arthritis assessment [100].

CT: Computed tomography provides enhanced bone detail and may help visualize fracture lines, displacement, osteolytic lesions around joint arthroplasty, and cortical disruption in cases of infection or neoplasia [39]. Three-dimensional CT reconstructions may help with preoperative planning for complex intra-articular fractures, multiplanar osteotomy for limb malalignment, and reconstitution of bone loss in joint arthroplasty [39]. Axial plane CT imaging of the hip and knee can help assess the rotational alignment of components of a total knee arthroplasty in cases of patellar maltracking [39]. Three-dimensional CT with remodeling is used for preoperative planning for reconstruction associated with dysplasia, post-trauma planning, and complex total knee arthroplasty planning [100].

Bone scan: Nuclear medicine studies provide a nonspecific assessment that does not define the etiology of an abnormality but indicates the presence of an abnormality that may correlate with a clinical concern [39]. Technetium-99 (Tc-99) radionuclide imaging may help identify infection, neoplasia, occult fracture, bone healing, active phases of heterotopic ossification, implant loosening, or failure of osseointegration [39]. Gallium-67 (Ga-67) radionuclide imaging may help differentiate between aseptic and septic prosthetic loosening [39].

Other Considerations: Physical examination along with radiographic or advanced imaging findings must be used concomitantly to determine the source of each patient’s symptoms and to determine appropriate surgical intervention when nonsurgical measures have failed [20]. Assessment of the joint must combine physical examination along with radiographic (including full-length alignment views) and MRI findings [62]. Choosing the correct intervention for articular cartilage injuries depends on careful analysis of the patient's physical examination, activity levels, and imaging findings [13]. A randomized controlled trial found no effect of MRI on the decision to perform arthroscopy or patient outcome [143]. Conversely, the use of MRI can reduce the requirements for diagnostic arthroscopy [127]. Mastery of basic diagnostic arthroscopy is a critical tool for orthopaedic surgeons treating disorders of the knee [17]. Before establishing the indication for knee arthroscopy in children, it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures [6]. The chronicity, severity, and focal versus generalized nature of a patient’s cartilage injury guides treatment, with surgical options including arthroscopic débridement, osteochondral grafting, realignment osteotomy, or knee arthroplasty [20]. Arthroscopy can be beneficial for patients with osteoarthritis and mechanical symptoms recalcitrant to conservative care, but this should not be the first-line intervention [62]. Arthroscopic treatment is indicated for débridement, chondroplasty, loose body removal, microfracture, and partial meniscectomy [62]. Treatment for focal cartilage lesions depends upon the lesion size, lesion location, and the status of the underlying subchondral bone [62]. Assessing the potential instability of an osteochondritis dissecans lesion is key to early treatment [102]. Surgical intervention should be considered for patients having unstable osteochondritis dissecans lesions of the knee and/or lesions that do not heal with nonsurgical treatment such as activity modification [102]. Further studies focusing specifically on the younger patient with osteoarthritis are needed to delineate the benefit arthroscopy may have in this specific patient population [52]. Recommendations set forth by landmark clinical trials and the AAOS 2013 guidelines did not have a sudden impact within the studied geographic region, but there is some evidence to suggest a gradual shift in treatment where knee arthroscopy is withheld near imminent knee arthroplasty [3]. Mastery of chondroplasty and meniscectomy will allow the surgeon to effectively treat 2 of the most common pathologies encountered on knee arthroscopy [30].

Treatment

Non-Operative

Knee arthroscopy is indicated only after the failure of nonsurgical care [46]. While arthroscopic débridement may provide relief from mechanical symptoms in carefully selected osteoarthritis (OA) patients, it should not be offered as a first-line treatment in lieu of nonsurgical measures [62].

Operative

Indications: Arthroscopic intervention is an acceptable treatment for appropriately indicated patients following the failure of nonsurgical care [46]. In the setting of nonfocal cartilage loss, surgery may be considered for alleviation of mechanical symptoms or significant effusion related to meniscal pathology, articular cartilage flaps, or loose bodies [46]. Patients with mechanical symptoms may specifically benefit from arthroscopic débridement, including partial meniscectomy and chondroplasty [46]. MRI scans are not routinely necessary as an indication for knee arthroscopy, as clinical examination and plain radiograph are sufficient [26].

Surgical Approach / Technique: The anterolateral portal is established first, located directly adjacent to the lateral patellar tendon edge at the level of the joint line [46]. An anteromedial portal is established under direct visualization, first using a spinal needle to determine appropriate portal position and trajectory [46]. Most basic arthroscopic procedures can be completed with the anterolateral and anteromedial portals [46]. Posteromedial and posterolateral portals may be necessary to retrieve loose bodies behind the cruciate ligaments or to treat injuries of the meniscal roots [46]. These posterior portals should be placed under direct arthroscopic visualization using a spinal needle for localization, entering the skin 1 cm proximal to the joint line and just posterior to the medial collateral ligament or lateral collateral ligament, respectively [46]. At least 2 posteromedial portals can be safely placed in the knee [33]. Learning posterior knee arthroscopy is necessary, and the technique must be part of arthroscopy education [63].

During chondroplasty, diseased cartilage is removed or stabilized using a shaver, laser, or radiofrequency probe [31]. In abrasion arthroplasty, an arthroscopic shaver is used to débride cartilage defects and penetrate the subchondral bone plate to cause bleeding [31]. For subchondral drilling or microfracture, cartilage defects are débrided to a stable rim, and the resulting exposed subchondral bone is penetrated with a small drill or awl [31]. Percutaneous MCL release during knee arthroscopy increases the medial tibiofemoral joint space without causing significant short- or long-term complications, including residual valgus instability, pain, loss of function, or damage to surrounding structures [81]. This procedure improves visualization and facilitates instrumentation by providing an almost 2x wider working space within the medial tibiofemoral joint [200]. Similarly, the procedure allows the lateral joint space to be temporarily widened, significantly improving visualization and instrumentation during lateral meniscus repair [79]. Although some points in the technique can be improved, the hanger-lifting method is useful in joint surgeries [108].

Arthroscopic techniques have been used to evaluate fractures of the anterior intercondylar eminence of the tibia, to reduce such fractures, and, after reduction, to fix the eminence with percutaneously inserted internal fixation [146]. Arthroscopy has been advocated to assess the degree of articular surface depression and the adequacy of reduction after tibial plateau fractures [146]. Fracture patterns appropriate for arthroscopic management are those that can be internally fixed with a cancellous screw and do not require a major reduction or use of a buttress plate [146]. In the setting of symptomatic total knee arthroplasty (TKA), although carrying certain risks for periprosthetic joint infection (PJI) and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up [53]. Arthroscopic knee joint lavage leads to a lasting improvement in pain and functional impairment [36].

Pain Management: Knee arthroscopy under local anaesthesia may be considered as a reliable, well tolerated and safe alternative to conventional procedures [112]. However, 0.9% of primary arthroscopies performed under local anaesthesia could not be performed safely due to patient discomfort [132]. Intraarticular injections of local anaesthetics seem to provide an alternative and effective solution in pain control after knee arthroscopy [113]. Single-dose intra-articular bupivacaine was shown to be significantly better than placebo at relieving pain after knee arthroscopic surgery [160]. Of 6 common postoperative intra-articular analgesics, magnesium plus bupivacaine provides the most effective pain relief without increasing short-term side effects after knee arthroscopy [138]. Adding dexmedetomidine to local anesthetics in intra-articular injections for knee arthroscopy significantly extended analgesia duration and lowered pain scores and opioid use, although these effects did not reach the minimal clinically important difference [158]. Midazolam intervention is revealed to substantially reduce the pain scores, the number of patients requiring analgesics, and analgesic consumption, as well as improve the time to first analgesic requirement after knee arthroscopy [148]. Perioperative nonopioid analgesia interventions should be considered in efforts to reduce opioid consumption in patients undergoing knee arthroscopy [150]. Current opioid prescribing habits exceed the need for postoperative pain management after knee arthroscopy [137]. Current expert panel guidelines recommend an excess of opioids following knee arthroscopy [117]. In addition to decreased early NRS scores and nausea, blocks of the infrapatellar branch of the saphenous nerve demonstrated potential benefit at twelve weeks after simple knee arthroscopy [162]. This study provides evidence that preoperative resilience score, as measured by the BRS, does not correlate with postoperative patient-reported functional outcome or satisfaction with a nonopioid pain regimen after knee arthroscopy [154].

Setting of Care: Ambulatory knee arthroscopic surgery emerged as a cost-saving strategy over inpatient surgery, driven by lower treatment costs and enhanced health-related quality of life [110]. There is an obvious room for further standardisation in the routine handling of patients undergoing elective arthroscopy of the knee [32].

Other Considerations: Simple arthroscopic knee-surgery is safe, and has a low rate of complications [43]. A landmark study by Moseley et al comparing arthroscopic débridement with sham surgery in patients with knee arthritis found no difference in postoperative pain or functional outcomes between groups [46]. Several subsequent studies specifically assessing outcomes after partial meniscectomy versus physical therapy for patients with knee osteoarthritis (OA) and a meniscal tear similarly have demonstrated no significant difference in outcomes between groups [46]. About 30% of patients randomized to the physical therapy group crossed over and choose to undergo surgery because of continued pain, and good outcomes were achieved in patients who crossed over [46]. This suggests that while surgery should not be the initial recommendation for most patients with arthritis, even in the presence of meniscal tear, those who fail to improve with conservative measures can have good outcomes with delayed meniscectomy [46]. Patients may continue to have pain because of underlying OA, but mechanical symptoms are more reliably improved [62]. TKA performed within 35 weeks of prior ipsilateral knee arthroscopy was associated with significantly higher rates of all-cause revision surgery and PJI compared with TKA without prior knee arthroscopy [80]. Knee arthroscopy within two years of unicompartmental knee arthroplasty is associated with an increased rate of conversion to total knee arthroplasty and a higher rate of failure from aseptic loosening [74]. These data are reassuring and valuable in an era in which many candidates for TKA will have had previous arthroscopic knee surgery [27]. This suggests that the recommendations set forth by landmark clinical trials and the AAOS 2013 guidelines did not have a sudden impact within our geographic region, but there is some evidence to suggest a gradual shift in treatment, where knee arthroscopy is withheld near imminent knee arthroplasty [3]. Further studies focusing specifically on the younger patient with OA are needed to delineate the benefit arthroscopy may have in this specific patient population [52]. The reported incidence of neurovascular complication is low, but it may be underestimated [12]. Many neurovascular complications that occur are preventable with a thorough understanding of neurovascular anatomy, good preoperative and intraoperative planning, and attention to the details of basic techniques and the equipment used for the procedure [12]. The authors caution against the use of steroid injections within one month following knee arthroscopy [67]. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy [44].

Complications

Overall Incidence and Safety: Large series published in the late 1980s reported overall complication rates for knee arthroscopy of less than 2% [136]. More recent reports generally cite overall complication rates of less than 1% [136]. Four large series with a combined total of 191,584 arthroscopic knee procedures reported complications in 1,175 (0.6%) [136]. Data from the American Board of Orthopaedic Surgery from 2003 to 2009 showed an overall complication rate of almost 5%, with a range of 2.5% for meniscectomy to 20% for PCL reconstruction [136]. Infection was the most common complication overall in the American Board of Orthopaedic Surgery data from 2003 to 2009 [136]. Complications increase with the difficulty of the case [136]. The rate of unplanned readmissions within 30 days of shoulder and knee arthroscopic procedures is low, at 0.92%, with wound-related complications being the most common cause [205].

Thromboembolism: Symptomatic VTEs were rare and occurred infrequently (0.34%) after knee arthroscopy in the absence of routine chemoprophylaxis [122]. The incidence of proximal DVT is very low after arthroscopic surgery regardless of receiving prophylaxis or not [123]. The total incidence of VTE diagnosed with venography after arthroscopic knee surgery was 14.9%, of which only 3.7% were symptomatic cases, indicating 11.2% silent cases of VTE [167]. The incidence of VTE after knee arthroscopy was 16.7% at the 2-week follow-up [125]. DVT is the most common complication of knee arthroscopy and also the most common non-respiratory events of COVID-19 infection [164]. Although venous thromboembolic disease (VTED) after knee arthroscopy usually arises as a silent deep vein thrombosis, it can occasionally lead to fatal pulmonary embolism [173]. There is no significant difference in the risk reduction of PEs, symptomatic DVTs, major/minor bleeding, and/or all-cause mortality when using LMWH, rivaroxaban, graduated compression stockings or no treatment following arthroscopic knee surgery [175]. Prophylactic enoxaparin after knee arthroscopy was associated with a significantly reduced risk of symptomatic VTE within 95 days of discharge compared with no pharmacological prophylaxis [171]. The author concludes that nearly all patients should receive some form of thromboprophylaxis after knee arthroscopy, with aspirin recommended for low-risk patients and stronger anticoagulants for high-risk patients, despite the low absolute risk reduction [194]. This study demonstrated the efficacy of a risk-based protocol to reduce the risk of VTE and limit costs and adverse events following knee arthroscopy [159]. There are distinct differences in thrombosis risk per person after knee arthroscopy [68]. Combined oral contraceptive use is associated with an increased risk for a symptomatic DVT or PE after knee arthroscopy [180]. A procedure performed at an altitude greater than or equal to 4,000 ft was a significant risk factor for the development of postoperative VTE compared with matched patients undergoing the same procedure at an altitude less than or equal to 100 ft [185]. The cases serve as a reminder of the importance of always considering the potential risk of DVT and PE in every case of knee arthroscopy, appropriately discussing the possibility of this complication with the patient pre-operatively, and documenting that discussion in the medical record [149].

Infection: Post-arthroscopic knee infections were more frequent among morbidly obese patients, tobacco users, patients undergoing relatively complex procedures, men, obese patients, diabetic patients, relatively young patients, and patients with increased comorbidity burdens [206]. The present study identified numerous patient-related risk factors independently associated with an increased risk of infection following knee arthroscopy in PP and Medicare-aged patients [199]. Patients undergoing knee arthroscopy who receive an intra-articular CSI during the perioperative period can be expected to experience significantly higher postoperative infection rates when compared with patients not receiving an injection [97]. The present study demonstrates a significant increase in postoperative infection in Medicare patients who underwent ipsilateral intra-articular knee corticosteroid injections at the time of knee arthroscopy compared with a matched control group without intraoperative injection [211]. While the overall risk remains low, the use of intra-operative steroids is expected to result in one additional knee infection for every 448 arthroscopic procedures performed [201]. There is a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both Medicare and private payer patients after knee arthroscopy compared to patients with steroid injections more than 4 weeks postoperatively [212]. There is a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both Medicare and private payer patients after knee arthroscopy compared with patients with steroid injections more than 4 weeks postoperatively and matched controls who did not receive injections [213]. Corticosteroid injections given within 2 weeks after knee arthroscopy increase the risk of postoperative infection the most, whereas injections given within 4 weeks increase the risk but to a lesser degree [207]. A periprosthetic joint infection is a rare complication of knee arthroscopy after total knee arthroplasty, and the rate of infection is not significantly increased compared to patients undergoing total knee arthroplasty alone [191]. KA after TKA was associated with increased infection-related and all-cause revision [202].

Nerve palsy: Neurovascular complications are among the most serious and devastating complications of knee arthroscopy [12]. Saphenous and peroneal nerve injuries are still being reported with arthroscopic repairs; however, with all-inside techniques the frequency of these injuries has decreased dramatically [136].

Stiffness / Arthrofibrosis: The incidence of arthrofibrosis associated with anterior cruciate ligament reconstruction is increased when meniscal repair is performed [136].

Other Considerations: The incidence of infection associated with anterior cruciate ligament reconstructions is slightly increased when the reconstruction is performed in conjunction with meniscal repair [136]. The incidence of previously undiagnosed hemophilia presenting as a cause for postoperative complications following knee arthroscopy is exceedingly rare [210]. In patients undergoing knee arthroscopy, this study failed to detect a significant increased risk of major complications associated with having a BMI >40 [45].

Recovery

Light activity (weeks): Return to driving is safe at 6 weeks after knee arthroscopic procedures [105].

Full activity (months): Standard knee arthroscopy using a two-portal technique allows for a faster return to normal activity compared to the three-portal technique [214].

Rehabilitation protocol: Standard knee arthroscopy using a two-portal technique allows for an earlier return of quadriceps muscle function and strength compared to the three-portal technique [214]. This approach also permits earlier rehabilitation compared to the three-portal technique [214]. Continuous passive motion (CPM) is not warranted in post-operative protocols following arthroscopic surgery because of its limited effectiveness in returning knee range of motion [131].

Other Considerations: The choice of anesthesia does not influence recovery at 6 months after knee arthroscopy [22]. Delayed portal-tract wound healing is strongly associated with the post-operative sub-acute and chronic knee pain after arthroscopic procedures [204]. Portal-site tracts delayed closure is a potential for post-operative sub-acute and chronic anterior knee pain after arthroscopic surgery [203]. In patients with osteogenesis imperfecta, 81% regain full knee ROM post-operatively [177], and 83% of encounters (86% of patients) return to full pre-operative physical activity level [177]. The rate of any complication for this population is 50% [177], with a revision surgery rate of 27% [177].

Key Evidence

• [L2] The absolute risks of complications associated with knee arthroscopy remain small at about 1%. [1] (10.1186/s12891-018-2102-y)
• [L4] Most patients had no knee-related activity restriction 4 weeks after arthroscopy. [2] (10.1016/j.arthro.2007.07.026)
• [L3] This suggests that the recommendations set forth by landmark clinical trials and the AAOS 2013 guidelines did not have a sudden impact within our geographic region, but there is some evidence to suggest a gradual shift in treatment, where knee arthroscopy is withheld near imminent knee arthroplasty. [3] (10.1016/j.asmr.2021.02.006)
• [L3] Knee arthroscopy is a valuable treatment for patients with radiological signs of severe osteoarthritis. [4] (10.1007/s00402-002-0425-4)
• [L1] Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment including exercise therapy for 3 months does not relieve patients symptoms. [5] (10.1177/03635465241255653)
• [L4] Before establishing the indication for knee arthroscopy it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures. [6] (10.1007/s001670050194)
• [L4] Major complications following knee arthroscopy in children and adolescents are relatively low at 1.4%. [7] (10.1177/2325967113s00078)
• [L3] Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. [9] (10.1007/s00167-019-05638-5)
• [L3] Routine pathological examination of surgical specimens from patients undergoing knee arthroscopy had limited cost-effectiveness because of the low prevalence of findings that altered patient management. [10] (10.2106/jbjs.m.01083)
• [L4] [12] (10.1177/03635465020300042501)
• [L5] The high rate of knee arthroscopy prior to total knee arthroplasty should provide clinicians with another reminder of the importance of avoiding knee arthroscopy in patients with severe osteoarthritis. [14] (10.2106/jbjs.21.00074)
• [L4] Knee arthroscopy is useful in providing a definitive diagnosis in pediatric patients with knee pain, while preoperative diagnosis based on clinical and imaging evaluations should be interpreted with caution. [15] (10.1007/s00402-013-1725-6)
• [L4] Major complications after knee arthroscopy in children and adolescents are rare, but minor complications are more common. [16] (10.1016/j.arthro.2014.02.028)
• [Paper] Mastery of basic diagnostic arthroscopy is a critical tool for orthopaedic surgeons treating disorders of the knee. [17] (10.1016/j.eats.2013.07.012)
• [L3] Prior knee arthroscopy is significantly associated with increased 2-year TKA revision rate. [18] (10.1016/j.arth.2019.08.043)
• [L1] The benefit of knee arthroscopic surgery, seen at 1 year in middle-aged patients with meniscal symptoms, was diminished at 3 years and was no longer statistically significant. [19] (10.1177/0363546517701431)
• [L2] Use of this sign in routine knee arthroscopy can be helpful, particularly during screening procedure and in exploring tears which are usually not seen easily through routine portals. [21] (10.1186/s12891-015-0800-2)
• [L1] The choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months after knee arthroscopy. [22] (10.1177/03635465020300012401)
• [L5] The entirety of the small knee is assessable via standard diagnostic arthroscopy when a 2.7mm arthroscope is utilized, suggesting intraarticular pathology can be reliably identified. [23] (10.1177/2325967120s00267)
• [L3] The data suggests that MRI scans are not routinely necessary as an indication for knee arthroscopy, as clinical examination and plain radiograph are sufficient. [26] (10.1007/s00167-009-0835-8)
• [L3] These data are reassuring and valuable in an era in which many candidates for TKA will have had previous arthroscopic knee surgery. [27] (10.1016/j.arth.2017.06.052)
• [L3] Scores on a knee arthroscopy exercise were significantly improved after the programme, with the greatest improvements observed in operative time and motion sparing among less experienced surgeons. [29] (10.1016/j.otsr.2019.09.008)
• [Paper] Mastery of chondroplasty and meniscectomy will allow the surgeon to effectively treat 2 of the most common pathologies encountered on knee arthroscopy. [30] (10.1016/j.eats.2013.07.011)
• [L4] There is an obvious room for further standardisation in the routine handling of patients undergoing elective arthroscopy of the knee. [32] (10.1007/s00167-010-1266-2)
• [L5] At least 2 posteromedial portals can be safely placed in the knee. [33] (10.1016/j.arthro.2011.02.031)
• [L1] The combination of MFAT and knee arthroscopy demonstrates significant short-term efficacy in pain relief and joint function improvement, with a favorable safety profile. [35] (10.1186/s13018-025-06006-5)
• [L1] Arthroscopic knee joint lavage leads to a lasting improvement in pain and functional impairment. [36] (10.1007/s00167-006-0260-1)
• [L3] A 10.2% failure rate 1 year after knee arthroscopy may be a reasonable benchmark against which performance of knee arthroscopy in patients older than 65 years can be measured. [37] (10.1016/j.arth.2010.03.001)
• [L4] Patient and/or surgeons preference may play a large role in the decision to perform an arthroscopy without a valid indication. [41] (10.1007/s00167-021-06615-7)
• [L4] Simple arthroscopic knee-surgery is safe, and has a low rate of complications. [43] (10.1007/s00167-005-0694-x)
• [Case_report] Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. [44] (10.1186/s12891-021-04266-w)
• [L4] In patients undergoing knee arthroscopy, this study failed to detect a significant increased risk of major complications associated with having a BMI >40. [45] (10.1016/j.arthro.2019.06.039)
• [L2] [48] (10.1016/j.arthro.2008.10.020)
• [L5] Routine medical thromboprophylaxis following knee arthroscopy has low utility because the overall rate of symptomatic venous thromboembolism is relatively low. [49] (10.1002/arj.70342)
• [L3] Previous knee arthroscopy should be considered a factor related to postoperative primary TKA outcomes, demonstrated by a higher rate of postoperative complications and failures as well as a worse survival curve compared to patients without previous surgery. [50] (10.1007/s00167-008-0669-9)
• [L3] Further studies focusing specifically on the younger patient with OA are needed to delineate the benefit arthroscopy may have in this specific patient population. [52] (10.1016/j.arth.2013.05.024)
• [L4] In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. [53] (10.1186/s13018-020-02112-8)
• [L5] Evidence suggests that learning posterior knee arthroscopy is necessary and the technique must be part of arthroscopy education. [63] (10.1530/eor-22-0133)
• [Paper] If this sign is observed during arthroscopic procedure, surgeons should ensure they probe the medial meniscus carefully and treat accordingly. [65] (10.1016/j.eats.2019.10.004)
• [L3] ACL rupture and symptomatic cartilage lesions exhibit distinct synovial fluid inflammatory profiles at the time of arthroscopic knee surgery. [66] (10.1177/2325967125s00226)
• [L3] The authors caution against the use of steroid injections within one month following knee arthroscopy. [67] (10.1177/2325967119s00358)
• [L3] There are distinct differences in thrombosis risk per person after knee arthroscopy. [68] (10.1016/j.arthro.2017.08.113)
• [L5] The decline in knee arthroscopy utilization for degenerative meniscus tears is driven by changes in healthcare economics, reimbursement rates, and growing evidence questioning the efficacy of the procedure. [70] (10.1016/j.arthro.2024.03.019)
• [L3] Knee arthroscopy within two years of unicompartmental knee arthroplasty is associated with an increased rate of conversion to total knee arthroplasty and a higher rate of failure from aseptic loosening. [74] (10.1016/j.arth.2020.10.060)
• [L4] The procedure allows the lateral joint space to be temporarily widened, significantly improving visualization and instrumentation during lateral meniscus repair. [79] (10.1016/j.eats.2025.103670)
• [L3] TKA performed within 35 weeks of prior ipsilateral knee arthroscopy was associated with significantly higher rates of all-cause revision surgery and PJI compared with TKA without prior knee arthroscopy. [80] (10.2106/jbjs.20.00218)
• [L4] Percutaneous MCL release during knee arthroscopy is a method of increasing the medial tibiofemoral joint space without causing any significant short- or longterm complications including residual valgus instability, pain, loss of function, or damage to surrounding structures. [81] (10.1016/j.arthro.2019.08.051)
• [L3] Patients undergoing knee arthroscopy who receive an intra-articular CSI during the perioperative period can be expected to experience significantly higher postoperative infection rates when compared with patients not receiving an injection. [97] (10.1177/23259671211032941)
• [L1] On the basis of these results, it would be safe to recommend a return to driving at 6 weeks after knee arthroscopic procedures and 4 weeks after hip arthroscopic procedures. [105] (10.1016/j.asmr.2021.08.015)
• [L4] Although some points in the technique can be improved, this method is useful in joint surgeries. [108] (10.1016/j.arthro.2008.06.013)
• [L4] Ambulatory knee arthroscopic surgery emerged as a cost-saving strategy over inpatient surgery, driven by lower treatment costs and enhanced health-related quality of life. [110] (10.1002/ksa.12157)
• [L4] The ROCK OCD Knee arthroscopy classification system demonstrated high reliability. [111] (10.1177/2325967113s00074)
• [L4] It is concluded that knee arthroscopy under local anaesthesia may be considered as a reliable, well tolerated and safe alternative to conventional procedures. [112] (10.1016/0020-1383(95)00168-9)
• [L2] Intraarticular injections of local anaesthetics seem to provide an alternative and effective solution in pain control after knee arthroscopy. [113] (10.1186/1749-799x-1-17)
• [L3] Current expert panel guidelines recommend an excess of opioids following knee arthroscopy. [117] (10.1177/2325967120s00393)
• [L3] Symptomatic VTEs were rare and occurred infrequently (0.34%) after knee arthroscopy in the absence of routine chemoprophylaxis. [122] (10.1016/j.arthro.2015.04.091)
• [L4] The incidence of proximal DVT is very low after arthroscopic surgery regardless of receiving prophylaxis or not. [123] (10.1016/j.arthro.2013.12.021)
• [L3] The incidence of VTE after knee arthroscopy was 16.7% at the 2-week follow-up. [125] (10.1177/23259671241257820)
• [L2] Synovial fluid levels of MCP-1 and IL-6 are strong predictors of severe cartilage lesions independent of other injuries, and predict worse clinical outcomes at 1 year after knee arthroscopy. [126] (10.1016/j.arthro.2014.04.075)
• [L2] The use of MRI can reduce the requirements for diagnostic arthroscopy. [127] (10.1016/0020-1383(93)90100-k)
• [L2] CPM is not warranted in post-operative protocols following arthroscopic surgery because of its limited effectiveness in returning knee range of motion. [131] (10.1007/s00167-016-4326-4)
• [L4] 0.9% of primary arthroscopies performed under local anaesthesia could not be performed safely due to patient discomfort. [132] (10.1007/s001670050171)
• [L2] Current opioid prescribing habits exceed the need for postoperative pain management after knee arthroscopy. [137] (10.1016/j.arthro.2020.10.019)
• [L1] Of 6 common postoperative intra-articular analgesics, magnesium plus bupivacaine provides the most effective pain relief without increasing short-term side effects after knee arthroscopy. [138] (10.1016/j.arthro.2022.03.013)
• [L1] We found no effect of MRI on the decision to perform arthroscopy or patient outcome. [143] (10.1016/j.arthro.2007.05.020)
• [L1] Midazolam intervention is revealed to substantially reduce the pain scores, the number of patients requiring analgesics, and analgesic consumption, as well as improve the time to first analgesic requirement after knee arthroscopy. [148] (10.1186/s13018-017-0682-0)
• [L4] The cases serve as a reminder of the importance of always considering the potential risk of DVT and PE in every case of knee arthroscopy, appropriately discussing the possibility of this complication with the patient pre-operatively, and documenting that discussion in the medical record. [149] (10.1007/s00167-009-1025-4)
• [L1] These interventions should be considered in efforts to reduce opioid consumption in patients undergoing knee arthroscopy. [150] (10.1007/s00167-020-06256-2)
• [L2] This study provides evidence that preoperative resilience score, as measured by the BRS, does not correlate with postoperative patient-reported functional outcome or satisfaction with a nonopioid pain regimen after knee arthroscopy. [154] (10.1016/j.arthro.2020.03.013)
• [L1] Adding dexmedetomidine to local anesthetics in intra-articular injections for knee arthroscopy significantly extended analgesia duration and lowered pain scores and opioid use, although these effects did not reach the minimal clinically important difference. [158] (10.1016/j.arthro.2024.06.043)
• [L3] This study demonstrated the efficacy of a risk-based protocol to reduce the risk of VTE and limit costs and adverse events following knee arthroscopy. [159] (10.1055/s-0040-1715090)
• [L1] Single-dose intra-articular bupivacaine was shown to be significantly better than placebo at relieving pain after knee arthroscopic surgery. [160] (10.1007/s00167-013-2543-7)
• [L3] This tool was able to distinguish among the novice, experienced, and expert levels in performing diagnostic arthroscopy. [161] (10.1016/j.arthro.2011.07.018)
• [L1] In addition to decreased early NRS scores and nausea, blocks of the infrapatellar branch of the saphenous nerve demonstrated potential benefit at twelve weeks after simple knee arthroscopy. [162] (10.2106/jbjs.l.01534)
• [L4] DVT is the most common complication of knee arthroscopy and also the most common non-respiratory events of COVID-19 infection. [164] (10.1177/2325967121s00862)
• [L4] The total incidence of VTE diagnosed with venography after arthroscopic knee surgery was 14.9%, of which only 3.7% were symptomatic cases, indicating 11.2% silent cases of VTE. [167] (10.1016/j.arthro.2014.02.043)
• [L3] [168] (10.1186/s12891-019-2518-z)
• [L3] Prophylactic enoxaparin after knee arthroscopy was associated with a significantly reduced risk of symptomatic VTE within 95 days of discharge compared with no pharmacological prophylaxis. [171] (10.1002/arj.70341)
• [L4] Although venous thromboembolic disease (VTED) after knee arthroscopy usually arises as a silent deep vein thrombosis, it can occasionally lead to fatal pulmonary embolism. [173] (10.1177/0363546503258876)
• [L1] There is no significant difference in the risk reduction of PEs, symptomatic DVTs, major/minor bleeding, and/or all-cause mortality when using LMWH, rivaroxaban, graduated compression stockings or no treatment following arthroscopic knee surgery. [175] (10.1007/s00167-021-06857-5)
• [L4] While most patients with OI who undergo KA can regain full ROM and return to their baseline activities, they should be counseled that the rate of any complication is 50% and the rate of revision surgery is 27%. 81% of patients regained full knee ROM post-operatively, and 83% of encounters (86% of patients) returned to full pre-operative physical activity level. [177] (10.1177/2325967126s00126)
• [L3] This study demonstrates that COCP use is associated with an increased risk for a symptomatic DVT or PE after knee arthroscopy and an increased risk for DVT, but not PE, after ACL reconstruction. [180] (10.1016/j.arthro.2020.10.025)
• [L3] In this study of knee arthroscopy in Medicare patients, a procedure performed at an altitude greater than or equal to 4,000 ft was a significant risk factor for the development of postoperative VTE compared with matched patients undergoing the same procedure at an altitude less than or equal to 100 ft. [185] (10.1016/j.arthro.2016.07.031)
• [L3] [186] (10.1016/j.arthro.2014.02.021)
• [L3] A periprosthetic joint infection is a rare complication of knee arthroscopy after total knee arthroplasty, and the rate of infection is not significantly increased compared to patients undergoing total knee arthroplasty alone. [191] (10.1016/j.arth.2024.02.057)
• [L5] The author concludes that nearly all patients should receive some form of thromboprophylaxis after knee arthroscopy, with aspirin recommended for low-risk patients and stronger anticoagulants for high-risk patients, despite the low absolute risk reduction. [194] (10.1016/j.arthro.2022.08.011)
• [L3] The present study identified numerous patient-related risk factors independently associated with an increased risk of infection following knee arthroscopy in PP and Medicare-aged patients. [199] (10.1016/j.knee.2017.02.002)
• [L4] Percutaneous MCL release during knee arthroscopy improves visualization and facilitates instrumentation by providing an almost 2x wider working space within the medial tibiofemoral joint. [200] (10.1016/j.asmr.2020.08.014)
• [L4] While the overall risk remains low, the use of intra-operative steroids is expected to result in one additional knee infection for every 448 arthroscopic procedures performed. [201] (10.1007/s00167-021-06763-w)
• [L3] KA after TKA was associated with increased infection-related and all-cause revision. [202] (10.1016/j.arth.2020.06.082)
• [L3] Both portal-site tracts delayed closure is a potential for post-operative sub-acute and chronic anterior knee pain after arthroscopic surgery. [203] (10.1177/2325967117s00082)
• [L3] Delayed portal-tract wound healing is strongly associated with the post-operative sub-acute and chronic knee pain after arthroscopic procedures. [204] (10.1016/j.aott.2017.05.002)
• [L3] The rate of unplanned readmissions within 30 days of shoulder and knee arthroscopic procedures is low, at 0.92%, with wound-related complications being the most common cause. [205] (10.1016/j.arthro.2015.03.029)
• [L4] Post-arthroscopic knee infections were more frequent among morbidly obese patients, tobacco users, patients undergoing relatively complex procedures, men, obese patients, diabetic patients, relatively young patients, and patients with increased comorbidity burdens in this study population. [206] (10.1016/j.arthro.2016.04.026)
• [L3] Corticosteroid injections given within 2 weeks after knee arthroscopy increase the risk of postoperative infection the most, whereas injections given within 4 weeks increase the risk but to a lesser degree. [207] (10.1016/j.arthro.2024.05.034)
• [Case_report] The incidence of previously undiagnosed hemophilia presenting as a cause for postoperative complications following knee arthroscopy is exceedingly rare. [210] (10.1016/j.asmr.2020.03.001)
• [L3] The present study demonstrates a significant increase in postoperative infection in Medicare patients who underwent ipsilateral intra-articular knee corticosteroid injections at the time of knee arthroscopy compared with a matched control group without intraoperative injection. [211] (10.1016/j.arthro.2015.09.003)
• [L3] There is a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both Medicare and private payer patients after knee arthroscopy compared to patients with steroid injections more than 4 weeks postoperatively. [212] (10.1016/j.arthro.2019.11.053)
• [L3] There is a significant association between intra-articular knee corticosteroid injections within 4 weeks of surgery and an increased incidence of postoperative infection in both Medicare and private payer patients after knee arthroscopy compared with patients with steroid injections more than 4 weeks postoperatively and matched controls who did not receive injections. [213] (10.1016/j.arthro.2019.01.025)
• [L1] Standard knee arthroscopy using a two-portal technique does not violate the vastus medialis obliquus muscle and allows for an earlier return of quadriceps muscle function and strength, earlier rehabilitation, and a faster return to normal activity compared to the three-portal technique. [214] (10.1177/03635465020300010301)

See Also

• Partial meniscectomy
• Knee osteoarthritis
• Meniscal tear
• Anatomy
• Meniscal repair

References

[1] Update on the risks of complications after knee arthroscopy. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2102-y

[2] Return to Activity After Knee Arthroscopy. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.07.026

[3] Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.02.006

[4] The value of knee arthroscopy in patients with severe radiological osteoarthritis. Archives of Orthopaedic and Trauma Surgery. 2002. DOI: 10.1007/s00402-002-0425-4

[5] Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 10-Year Follow-up of a Prospective, Randomized Controlled Trial. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241255653

[6] Algorithm for establishing the indication for knee arthroscopy in children: a comparison of adolescent and preadolescent children. Knee Surgery, Sports Traumatology, Arthroscopy. 2000. DOI: 10.1007/s001670050194

[7] Acute Complications of Pediatric and Adolescent Knee Arthroscopy. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113s00078

[9] Trends in knee arthroscopy utilization: a gap in knowledge translation. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05638-5

[10] Routine Examination of Pathology Specimens Following Knee Arthroscopy: A Cost-Effectiveness Analysis. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.01083

[12] Neurovascular Complications of Knee Arthroscopy. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300042501

[13] Chapter 41 Knee Arthroscopy and Preservation, Knee Reconstruction. 2020.

[14] Indications for Knee Arthroscopy in Patients with Osteoarthritis. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.21.00074

[15] Usefulness of knee arthroscopy for diagnosis of knee pain in pediatric patients: comparison with preoperative clinical diagnosis. Archives of Orthopaedic and Trauma Surgery. 2013. DOI: 10.1007/s00402-013-1725-6

[16] Acute and Subacute Complications of Pediatric and Adolescent Knee Arthroscopy. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.028

[17] Basic Knee Arthroscopy Part 3: Diagnostic Arthroscopy. Arthroscopy Techniques. 2013. DOI: 10.1016/j.eats.2013.07.012

[18] Prior Knee Arthroscopy Is Associated With Increased Risk of Revision After Total Knee Arthroplasty. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2019.08.043

[19] Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 3-Year Follow-up of a Prospective, Randomized Study. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517701431

[20] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Knee Arthroscopy and Preservation, Knee Reconstruction > Introduction.

[21] Validity of flounce sign to rule out medial meniscus tear in knee arthroscopy. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0800-2

[22] Knee Arthroscopy with the Use of Local Anesthesia—An Increased Risk for Repeat Arthroscopy?. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300012401

[23] CHALLENGES IN SMALL KNEE ARTHROSCOPY: A QUALITATIVE AND QUANTITATIVE PEDIATRIC CADAVERIC EXPERIENCE. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00267

[26] The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. Knee Surgery, Sports Traumatology, Arthroscopy. 2009. DOI: 10.1007/s00167-009-0835-8

[27] Prior Knee Arthroscopy Does Not Influence Long-Term Total Knee Arthroplasty Outcomes and Survivorship. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2017.06.052

[29] Lessons taught by a knee arthroscopy simulator about participants in a European arthroscopy training programme. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2019.09.008

[30] Basic Knee Arthroscopy Part 4: Chondroplasty, Meniscectomy, and Cruciate Ligament Evaluation. Arthroscopy Techniques. 2013. DOI: 10.1016/j.eats.2013.07.011

[31] Aaos Comprehensive Orthopaedic Review 3. Nonarthroplasty Surgical Treatment of the Knee > I. Arthroscopic Management of the Arthritic Knee.

[32] Knee arthroscopy routines and practice. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1266-2

[33] The Posteromedial Knee Arthroscopy Portal: A Cadaveric Study Defining a Safety Zone for Portal Placement. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.02.031

[35] Efficacy and safety of micro-fragmented adipose tissue combined with knee arthroscopy in the treatment of knee osteoarthritis: a systematic review. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06006-5

[36] Intra‐articular hyaluronic acid after knee arthroscopy: a two‐year study. Knee Surgery, Sports Traumatology, Arthroscopy. 2006. DOI: 10.1007/s00167-006-0260-1

[37] Temporal Relationship Between Knee Arthroscopy and Arthroplasty. The Journal of Arthroplasty. 2011. DOI: 10.1016/j.arth.2010.03.001

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[41] Performing a knee arthroscopy among patients with degenerative knee disease: one‐third is potentially low value care. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06615-7

[43] Complications in knee arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy. 2005. DOI: 10.1007/s00167-005-0694-x

[44] Bilateral pulmonary embolism without deep venous thrombosis was observed after knee arthroscopy: a case report. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04266-w

[45] Body Mass Index Screening in Knee Arthroscopy: An Analysis Using the National Surgical Quality Improvement Database. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.06.039

[46] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Knee Arthroscopy and Preservation, Knee Reconstruction > Knee Arthroscopy.

[48] The Accuracy of Magnetic Resonance Imaging Scanning and Its Influence on Management Decisions in Knee Surgery. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2008.10.020

[49] Editorial Commentary : Routine Medical Thromboprophylaxis Following Knee Arthroscopy Has Low Utility—If Any. Arthroscopy. 2026. DOI: 10.1002/arj.70342

[50] Is previous knee arthroscopy related to worse results in primary total knee arthroplasty?. Knee Surgery, Sports Traumatology, Arthroscopy. 2008. DOI: 10.1007/s00167-008-0669-9

[52] The Relationship Between Knee Arthroscopy and Arthroplasty in Patients Under 65Years of Age. The Journal of Arthroplasty. 2014. DOI: 10.1016/j.arth.2013.05.024

[53] The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-02112-8

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[63] Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques. EFORT Open Reviews. 2023. DOI: 10.1530/eor-22-0133

[65] Knee Arthroscopy: The “Crevice Sign,” a New Pathognomonic Sign for Unstable Posterior Medial Meniscal Tear in Anterior Cruciate Ligament–Deficient Knees. Arthroscopy Techniques. 2020. DOI: 10.1016/j.eats.2019.10.004

[66] Poster 129: ACL Injury and Cartilage Injury Exhibit Distinct Synovial Fluid Biomarker Profiles at Time of Knee Arthroscopy. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00226

[67] The Timing of Corticosteroid Injections following Knee Arthroscopy Influence Infection Risk. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00358

[68] Paper #150: Risk Factors Analysis of Venous Thromboembolism Events after Knee Arthroscopy: A Case‐Control Study. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.113

[70] Editorial Commentary: Utilization of Knee Arthroscopy for Degenerative Meniscus Tears Is on the Decline Alongside Reimbursement Rates. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.03.019

[74] Prior Knee Arthroscopy Increases the Failure Rate of Subsequent Unicompartmental Knee Arthroplasty. The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2020.10.060

[79] Lateral Collateral Ligament Partial Release Osteotomy Technique to Increase a Tight Lateral Knee Joint Space for Knee Arthroscopy. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103670

[80] Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.00218

[81] Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.08.051

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[105] Patients Generally May Return to Driving 4 Weeks After Hip Arthroscopy and 6 Weeks After Knee Arthroscopy: A Systematic Review and Meta‐analysis. Arthroscopy, Sports Medicine, and Rehabilitation. 2021. DOI: 10.1016/j.asmr.2021.08.015

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[108] Hanger‐Lifting Procedure in Knee Arthroscopy. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2008.06.013

[110] Ambulatory knee arthroscopic surgery yields cost savings and improved health outcomes. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12157

[111] Reliability of the ROCK Osteochondritis Dissecans Knee Arthroscopy Classification System - Multi-center Validation Study. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113s00074

[112] Knee arthroscopy under local anaesthesia: results and evaluation of patientssatisfaction. Injury. 1996. DOI: 10.1016/0020-1383(95)00168-9

[113] The intra-articular use of ropivacaine for the control of post knee arthroscopy pain. Journal of Orthopaedic Surgery and Research. 2006. DOI: 10.1186/1749-799x-1-17

[114] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Knee Anatomy > History and Physical Examination.

[117] An Evidence Driven Opioid Prescribing Guideline following Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00393

[122] Incidence and Risk Factor Analysis of Symptomatic Venous Thromboembolism After Knee Arthroscopy. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.04.091

[123] Deep Venous Thrombosis After Knee Arthroscopy: A Systematic Review and Meta‐Analysis. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2013.12.021

[125] Independent Risk Factors Associated With Venous Thromboembolism After Knee Arthroscopy: A Retrospective Study of 222 Patients. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241257820

[126] Identification of Synovial Fluid Biomarkers for Cartilage Pathology and Associated Outcomes in Knee Arthroscopy. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.075

[127] Influence of magnetic resonance imaging on a knee arthroscopy waiting list. Injury. 1993. DOI: 10.1016/0020-1383(93)90100-k

[131] The efficacy of post-operative devices following knee arthroscopic surgery: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4326-4

[132] Knee arthroscopy in local versus general anaesthesia. Knee Surgery, Sports Traumatology, Arthroscopy. 1999. DOI: 10.1007/s001670050171

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[137] Opioid Consumption After Knee Arthroscopy. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.10.019

[138] Intra‐Articular Magnesium Plus Bupivacaine Is the Most Effective and Safe Postoperative Analgesic Option Following Knee Arthroscopy: A Network Meta‐analysis. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.03.013

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[143] The Effect of Magnetic Resonance Imaging Scans on Knee Arthroscopy: Randomized Controlled Trial. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.05.020

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[148] The effect of midazolam on pain control after knee arthroscopy: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0682-0

[149] Thromboembolic complications after bilateral knee arthroscopic surgery patients. Knee Surgery, Sports Traumatology, Arthroscopy. 2009. DOI: 10.1007/s00167-009-1025-4

[150] Perioperative nonopioid analgesia reduces postoperative opioid consumption in knee arthroscopy: a systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06256-2

[154] Resilience as a Predictor of Patient Satisfaction With Nonopioid Pain Management and Patient‐Reported Outcome Measures After Knee Arthroscopy. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.03.013

[155] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC EXAMINATION AND DEBRIDEMENT OF THE ANKLE JOINT > KNEE.

[158] Adding Dexmedetomidne to Intra‐articular Local Anesthetics Results in Prolonged Analgesia After Knee Arthroscopy: A Systematic Review and Meta‐analysis. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.06.043

[159] Incidence of Venous Thromboembolism following Knee Arthroscopy: Effectiveness of a Risk-Based Stratified Chemoprophylaxis Protocol. The Journal of Knee Surgery. 2020. DOI: 10.1055/s-0040-1715090

[160] Single‐dose intra‐articular bupivacaine after knee arthroscopic surgery: a meta‐analysis of randomized placebo‐controlled studies. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2543-7

[161] Diagnostic Knee Arthroscopy: A Pilot Study to Evaluate Surgical Skills. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.07.018

[162] Nerve Block of the Infrapatellar Branch of the Saphenous Nerve in Knee Arthroscopy. The Journal of Bone & Joint Surgery. 2013. DOI: 10.2106/jbjs.l.01534

[164] When and What to Consider Knee Arthroscopy Surgery in Post-COVID 19 Infected Patients. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967121s00862

[167] Incidence of Symptomatic and Asymptomatic Venous Thromboembolism After Elective Knee Arthroscopic Surgery: A Retrospective Study With Routinely Applied Venography. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.043

[168] The association between smoking and knee osteoarthritis in a cohort of Danish patients undergoing knee arthroscopy. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2518-z

[171] Prophylactic Enoxaparin Reduces Symptomatic Venous Thromboembolism Compared With No Chemoprophylaxis Within 95 Days After Knee Arthroscopy. Arthroscopy. 2026. DOI: 10.1002/arj.70341

[173] Fatal Pulmonary Embolism after Knee Arthroscopy. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546503258876

[175] Thromboprophylaxis after knee arthroscopy does not decrease the risk of deep vein thrombosis: a network meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-021-06857-5

[177] Post-Surgical Outcomes in Pediatric and Adolescent Patients with Osteogenesis Imperfecta Undergoing Knee Arthroscopy. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00126

[180] Combined Oral Contraceptive Use Increases the Risk of Venous Thromboembolism After Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction: An Analysis of 64,165 Patients in the Truven Database. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.10.025

[185] High Altitude Is an Independent Risk Factor for Postoperative Symptomatic Venous Thromboembolism After Knee Arthroscopy: A Matched Case‐Control Study of Medicare Patients. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.07.031

[186] The Knee Arthroscopy Learning Curve: Quantitative Assessment of Surgical Skills. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.021

[191] Knee Arthroscopy Following Total Knee Arthroplasty is Not Associated With an Elevated Risk of Infection. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.02.057

[194] Editorial Commentary : Prophylaxis Against Deep Venous Thrombosis Should Be the Norm After Knee Arthroscopy. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.08.011

[199] Patient-related risk factors for infection following knee arthroscopy: An analysis of over 700,000 patients from two large databases. The Knee. 2017. DOI: 10.1016/j.knee.2017.02.002

[200] Percutaneous Medial Collateral Ligament Release Improves Medial Compartment Access During Knee Arthroscopy. Arthroscopy, Sports Medicine, and Rehabilitation. 2020. DOI: 10.1016/j.asmr.2020.08.014

[201] Intra‐articular steroid injection at the time of knee arthroscopy increases risk of post‐operative infection. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06763-w

[202] Knee Arthroscopy After Total Knee Arthroplasty: Not a Benign Procedure. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.06.082

[203] Portal-site tract delayed closure in knee arthroscopy. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00082

[204] The assessment of portal-tract healing after knee arthroscopy. Acta Orthopaedica et Traumatologica Turcica. 2020. DOI: 10.1016/j.aott.2017.05.002

[205] Causes and Predictors of 30‐Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.03.029

[206] Risk Factors for Infection After Knee Arthroscopy: Analysis of 595,083 Cases From 3 United States Databases. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.04.026

[207] Corticosteroid Injections Within 2 Weeks After Knee Arthroscopy Are Associated With Increased Infection Risk. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.05.034

[210] A Novel Case of Recurrent Hemarthrosis Following Knee Arthroscopy in a Patient with Undiagnosed Hemophilia. Arthroscopy, Sports Medicine, and Rehabilitation. 2020. DOI: 10.1016/j.asmr.2020.03.001

[211] Intraoperative Corticosteroid Injection at the Time of Knee Arthroscopy Is Associated With Increased Postoperative Infection Rates in a Large Medicare Population. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.09.003

[212] The Timing of Corticosteroid Injections Following Knee Arthroscopy Influence Infection Risk. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.053

[213] The Timing of Corticosteroid Injections Following Simple Knee Arthroscopy Is Associated With Infection Risk. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.01.025

[214] Two- versus Three-Portal Technique for Routine Knee Arthroscopy. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300010301