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The place of arthroscopy in the diagnosis and treatment of internal derangement of the knee: an analysis of 1000 cases.

An analysis of 1,000 consecutive arthroscopies of the knee, representing almost 10 years' experience, has made it possible to identify the patient in whom arthroscopy is deemed essential, very useful, or in some instances, superfluous. In the latter category are the young, often teenagers, with pain as their main symptom and no positive physical findings. In osteochondritis dissecans, added information beyond that supplied by X-rays was obtained infrequently, and routine arthroscopy for chondromalacia of the patella is probably unnecessary. Pain and other symptoms in the older age group are more likely to be the result of intra-articular pathology. Arthroscopy has been most helpful in making an accurate diagnosis, planning a surgery, and in some cases, avoiding unnecessary surgery. When a meniscal tear is suspected and arthrotomy comtemplated, arthroscopy is done routinely because it is now evident that the diagnostic accuracy of arthroscopy in experienced hands is at least 20% greater than clinical diagnostic accuracy. As a research tool, arthroscopy has proved to be an excellent method of adding to our knowledge of the fate of damaged articular cartilage. As a therapeutic tool, its use in meniscectomy and other forms of intra-articular surgery has established a new frontier for orthopedic surgery. Intra-articular arthroscopic surgery requires special training and more than average technical skill.