A concept for treatment of sports related knee injuries

Sammanfattning: The aim of the present thesis was, to evaluate local anaesthesia as an anaesthetic technique when performing knee arthroscopies, from a clinical and economical point of view, and to describe the total costs for surgery of knee injuries caused by sport activities in Stockholm. In a retrospective study of 6519 arthroscopies, we tried to estimate the failure rate for knee arthroscopy in local anaesthesia compared to the same procedure in general anaesthesia. Failure was defined as a rearthroscopy within 180 days due to persisting clinical symptoms. Encouraged by the comparable results between local and general anaesthesia in this study a prospective, randomized study including 400 patients was designed. Two hundred patients were randomized to local anaesthesia, 100 patients to general anaesthesia and 100 to spinal anaesthesia. Ninety percent of the patients who had local anaesthesia were satisfied with the procedure. From the surgeon s point of view, technical problems were experienced in 5% of the procedures in local anaesthesia. Arthroscopy in local anaesthesia should be avoided if the patient has excessive synovitis. The results of the study led to the conclusion that elective knee arthroscopy can be performed under local anaesthesia in the majority of the patients. Furthermore the cost saving for an arthroscopy in local anaesthesia was SEK 1 011 per procedure compared to an arthroscopy in general or spinal anaesthesia with our described setup. The total hospital stay for patients was significantly lower for patients with local anaesthesia compared to both general and spinal anaesthesia. To determine health care costs for sports related knee surgery, we used data from three different databases an insurance company database including all players in the studied sports (football, floor ball, European team handball and ice hockey), the hospital patient record database and data from a county database containing information about all surgical procedures performed in Stockholm. The average knee surgery cost for all studied players in the population was SEK 108 in 1997. In conclusion, arthroscopy with local anaesthesia was an anaesthetic technique with clinical results comparable to other methods like general or spinal anaesthesia. Furthermore local anaesthesia was more cost and time effective. The total health costs for the community was low for players in football, floor ball, European team handball and ice hockey when their knee injuries were surgically treated.