Abstracts

These are the abstracts of the papers presented at the 15th Annual Meeting of the Arthroscopy Association of North America, which was held in Washington, D.C., April 11-14, 1996.

Local Anesthesia in Outpatient Knee Arthroscopy: A Comparison of Efficacy and Cost. Scott A. Linmer, Scott Shawen, John Lohnes, and William E. Garrett, Jr. Indianapolis, Indiana, North Potomac, Maryland, and Durham, North Carolina, U.S.A.

Purpose: To compare the efficacy, cost effective- ness and safety of general, regional, and local anesthe- sia when performing outpatient knee arthroscopy.

Materials and Methods: This study consisted of two portions. A retrospective review of 256 outpatient knee arthroscopies was performed. The types of anes- thesia used were general endotracheal, regional (epi- dural or spinal), and local. Comparisons were made between operative procedure, anesthesia procedure time, need for supplemental anesthesia, recovery room time and cost, pharmaceutical cost, and complications. A prospective study consisted of 100 consecutive out- patient knee arthroscopies performed using local anes- thesia. Data identical to the retrospective portion were obtained. Visual analog scales were used in a patient questionnaire completed at the first post operative visit to assess patient satisfaction with local anesthesia.

Results: The retrospective data revealed similar de- mographics and operative procedures performed in the three study groups. The difference between operative time and total anesthetic time for the local group was 35 minutes less than for regional, and 23 minutes less than for the general group. These differences were statis- tically significant (P = < .05). Total pharmaceutical cost was significantly less for the local group (P = < .05). Recovery room cost for the local anesthesia group averaged $134 compared to $450 for regional and $527 for general. This difference was significant (P = < .05). There were 19 complications with general anesthesia, 16 with regional anesthesia, and two with local. There were two regional and two local cases which required subsequent general anesthesia. The pro- spective data revealed nearly identical time and cost data. The patient questionnaire showed nearly universal acceptance and satisfaction with the use of local anes- thesia.

Conclusion: The use of local anesthesia for outpa- tient knee arthroscopy is safe, effective, and well ac- cepted. The use of local anesthesia was shown to save a minimum of $400 per case compared to the other anesthetic methods studied.

Anterior Cruciate Ligament Reconstruction in Ath- letes With Associated Osgood-Schlatter's Disease. John R. McCarroll, K. Donald Shelbourne, and Dipak V. Patel. Indianapolis, Indiana, U.S.A.

There is concern among some orthopedists that if an Osgood Schlatter ossicle is present in patients scheduled for an ACL reconstruction then an alternative graft other than the patellar tendon should be used as a graft source because of the theoretical possible adverse outcome sec- ondary to the ossicle. We report a series of 20 athletes with Osgood-Schlatter's disease (OSD) who underwent anterior cruciate ligament (ACL) reconstruction using an autogenous bone-patellar tendon-bone graft. All pa- tients had Osgood-Schlatter's lesion with a free floating ossicle as seen on a plain radiograph. At operation, the ossicle was excised and a graft was harvested from the central-third of the patellar tendon. The patients were reviewed at an average follow-up of 44 months (range 24 to 108 months). The postoperative assessment in- cluded clinical examination, KT-1000 testing, isokinetic testing and subjective score (using the modified Noyes' questionnaire).

At the time of latest review, all 20 patients had a stable knee. The average side-to-side difference on manual maximum KT-1000 assessment was 1.9 mm. Average time to return to sports was 5.2 months (range 2.6 to 8.9 months). All patients returned to their previ- ous level of activity. The mean modified Noyes' knee score was 96 (range 89 to 100). To date, no graft failure has occurred. Based on the results of this study, we believe that ACL reconstruction using the autogenous bone-patellar tendon-bone graft can be safely under- taken in athletes with OSD, without compromising the knee stability.

348 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 12, No 3 (June), 1996: pp 348-389