A concept for treatment of sports related knee injuries

The aim of the present thesis was, to evaluate local anaesthesia as ananaesthetic technique when performing knee arthroscopies, from a clinicaland economical point of view, and to describe the total costs for surgeryof knee injuries caused by sport activities in Stockholm.

In a retrospective study of 6519 arthroscopies, we tried to estimate thefailure rate for knee arthroscopy in local anaesthesia compared to thesame procedure in general anaesthesia. Failure was defined as arearthroscopy within 180 days due to persisting clinical symptoms.Encouraged by the comparable results between local and generalanaesthesia in this study a prospective, randomized study including 400patients was designed. Two hundred patients were randomized to localanaesthesia, 100 patients to general anaesthesia and 100 to spinalanaesthesia. Ninety percent of the patients who had local anaesthesiawere satisfied with the procedure. From the surgeon s point of view,technical problems were experienced in 5% of the procedures in localanaesthesia. Arthroscopy in local anaesthesia should be avoided if thepatient has excessive synovitis. The results of the study led to theconclusion that elective knee arthroscopy can be performed under localanaesthesia in the majority of the patients.

Furthermore the cost saving for an arthroscopy in local anaesthesia wasSEK 1 011 per procedure compared to an arthroscopy in general or spinalanaesthesia with our described setup. The total hospital stay forpatients was significantly lower for patients with local anaesthesiacompared to both general and spinal anaesthesia. To determine health carecosts for sports related knee surgery, we used data from three differentdatabases an insurance company database including all players in thestudied sports (football, floor ball, European team handball and icehockey), the hospital patient record database and data from a countydatabase containing information about all surgical procedures performedin Stockholm. The average knee surgery cost for all studied players inthe population was SEK 108 in 1997.

In conclusion, arthroscopy with local anaesthesia was an anaesthetictechnique with clinical results comparable to other methods like generalor spinal anaesthesia. Furthermore local anaesthesia was more cost andtime effective. The total health costs for the community was low forplayers in football, floor ball, European team handball and ice hockeywhen their knee injuries were surgically treated.

List of scientific papers

I. Forssblad M, Weidenhielm L (1999). Knee arthroscopy in local versus general anaesthesia. The incidence of rearthroscopy. Knee Surg Sports Traumatol Arthrosc. 7(5): 323-6.
https://pubmed.ncbi.nlm.nih.gov/10525703

II. Jacobson E, Forssblad M, Rosenberg J, Westman L, Weidenhielm L (2000). Can local anesthesia be recommended for routine use in elective knee arthroscopy? A comparison between local, spinal, and general anesthesia. Arthroscopy. 16(2): 183-90.
https://pubmed.ncbi.nlm.nih.gov/10705331

III. Forssblad M, Jacobson E, Weidenhielm L (2004). Knee arthroscopy with different anesthesia methods. A comparison of efficacy and cost. Knee Surg Sports Traumatol Arthrosc. [Accepted]

IV. Forssblad M, Weidebhielm L, Werner S (2004). Knee surgery costs in football, floor ball, European team handball and ice hockey. Scandinavian Journal of Medicine & Science in Sports. [Accepted]