Arthroscopic evaluation and treatment of the symptomatic previously operated knee.

One hundred seventy-six knees in 172 consecutive patients with persistent or recurrent symptoms following a previous operative procedure were reevaluated and treated arthroscopically. Most knees had multiple findings, which are described. On the basis of these findings, four categories were defined: (a) the degenerative group; (b) the new meniscal tear group; (c) the fibroarthrosis group; (d) the minor problems group. Preoperative radiographic and clinical findings were correlated with the arthroscopically defined category. Follow-up evaluation by either comprehensive examination or detailed questionnaire was possible in 110 patients, with a mean follow-up interval of 31.4 months. A subjective rating scale relating to symptom level, functional level, and perceived surgical benefit was used. Overall, 68% of the patients were rated as satisfactory. By category, the frequencies of satisfactory results were: the degenerative group, 81%; the new meniscal tear group, 100%; the fibroarthrosis group, 75%; and the minor problems group, 47%. Workers' compensation claims correlated with a lower percentage of satisfactory results. Preoperative characteristics of those in the minor problems group were described. The poor results in this group suggest that common findings such as mild surface damage, minor adhesions, and minor meniscal lesions are often not symptomatic. Conservative management rather than arthroscopy may be more appropriate for patients in this group whereas arthroscopy is more reliable in treating symptomatic knees in the other three groups.