Comparison of an Optical Catheter Office Arthroscope with a Standard Rigid Rod-Lens Arthroscope in the Evaluation of the Knee

Abstract

In a prospective, randomized study, 47 patients under went arthroscopic evaluation of the knee in an operat ing room setting with both a standard rod-lens arthro scope and a newer flexible optical catheter fiberoptic system. The goal of the study was to assess the diag nostic accuracy of the newer catheter system, which is recommended for use in the office setting. Forty-four patients were included in the data analysis, three were eliminated because we were unable to perform an adequate examination with the catheter scope second ary to intraarticular adhesions or excessive bleeding. A comparison of the two systems revealed an overall underestimation and underrecognition of intraarticular knee pathologic changes. Anterior cruciate ligament tears were missed in 3 of 21 knees; no posterior cru ciate ligament tears were detected by the rod-lens arthroscope in 44 knees, but one false-positive result was "seen" using the optical catheter device. Similar trends in diagnosis (sensitivity, 25% to 67%; specificity, 96% to 99%) were seen for tears of the medial and lateral menisci, chondral lesions, and the identification of loose bodies. We conclude from the results of this study that the use of the optical catheter system for arthroscopic evaluation and treatment of the knee in the office setting may result in a significant compro mise in visual acuity, resulting in missed and incorrect diagnoses.