Orthopedics Today Asks Dr. Mandelbaum Why It’s Time to Take Another Look at Second-Look Knee Arthroscopy

Historically, second-look arthroscopy has been used to assess healing in the knee joint postoperatively for research and non-research purposes. However, due to some of its risks and complications, as well as recent advances that have yielded better imaging of tissue and structures, orthopedic surgeons have looked for good alternatives to follow-up knee arthroscopy.

On the other hand, sources for this Cover Story discussed new in-office arthroscopy technology to get a less-invasive second-look at a cartilage or meniscal repair, for example. These techniques may mitigate undergoing a subsequent OR visit and some of the associated risks.

“Second-look arthroscopy, or diagnostic arthroscopy, if you will, which is a [broader] term, was historically performed in a setting where we did not know or needed to confirm a diagnosis in the absence of high-quality MRI to otherwise guide our decision-making,” Brian J. Cole, MD, MBA, associate chairman of the department of orthopedics at Midwest Orthopaedics at Rush, told Orthopedics Today. “But frankly, taking a history, performing a physical and maybe obtaining an X-ray or MRI may obviate the need for second-look arthroscopy in many instances simply for the purposes of obtaining a diagnosis.”

Sources said second-look arthroscopy is not standardized in the United States but is performed on a case-by-case or one-off basis. Robert G. Marx, MD, professor of orthopedic surgery at Hospital for Special Surgery and Weill Cornell Medical College, noted patients who are symptom-free after surgery should not be subjected to second-look arthroscopy as it may cause complications that may not have occurred otherwise.

Cole does not perform diagnostic second-look arthroscopy, but only uses second-look arthroscopy when the patient is symptomatic. During medically indicated second-look, patients may realize a therapeutic benefit. He told Orthopedics Today this tends to occur in patients who underwent cartilage repair in conjunction with meniscal transplants or osteochondral allografting.“If I do an operation on someone and they are symptom-free, I may be interested to see what is going on, but I will not subject that patient to another operation, the risks of surgery and the recovery, because I do not feel it is in their best interest unless they have been enrolled and consented to a research protocol where it would have stated ahead of time that was part of the deal,” Marx said.

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