The most important finding of the present study was the agreement between expert and non-expert arthroscopic knee surgeons in most aspects of clinical care. This survey explored numerous aspects of the perioperative and postoperative care of patients undergoing knee arthroscopy.
A consensus among Polish orthopaedists was reached in the preferential use of regional anaesthesia for knee arthroscopy. This is in agreement with world standards [20,21,22,23]. Regional anaesthesia, in contrast to general anaesthesia, is a simple, safe technique that is well accepted by patients and reduces the length of hospital stay. Therefore, experts and non-experts agreed on the short duration of hospital stay after knee arthroscopy (1-2 days). Polish surgeons also agreed on the lack of need for the routine recommendation of using a knee orthosis, which is in agreement with previous studies, showing no beneficial effect of bracing after knee arthroscopy [24, 25] or even indirect prevention of ACL re-rupture in cases of rehabilitation without a knee brace .
Pain control after knee arthroscopy is an important aspect of the patient experience. In this survey, all surgeons agreed that there is no need for intraarticular knee medications immediately after knee arthroscopy. This did not differ between the expert and non-expert surgeons. The presentation of pain is determined by the procedure of knee surgery, and previous studies have shown that a significant proportion of patients have only very mild or mild pain after knee arthroscopic procedures .
The current guidelines for thromboprophylaxis recommend the use of vitamin K antagonists (e.g., warfarin), low-molecular-weight heparins (LMW heparin) or aspirin [28,29,30]. Polish experts and non-experts agreed on the use of LMW heparin, following the recommendations regarding venous thromboembolism prevention in orthopaedic surgery and traumatology developed by Polish orthopaedic surgery experts under the auspices of the National Consultant for Orthopaedic Surgery and Traumatology and the chairman of the Polish Society for Orthopaedic Surgery and Traumatology .
Postoperative rehabilitation is crucial to achieve successful outcomes in patients undergoing knee arthroscopy , and the role of the surgeon is to educate patients about its importance. Polish surgeons agreed that proper postoperative rehabilitation of the knee is essential for returning to an active lifestyle. In our survey, 99% of the surgeons reported that they discussed the importance of compliance with the rehabilitation protocol with the patient. However, there is still room for improvement, since 1% of surgeons never recommend rehabilitation, 5% - rarely and 7% - only sometimes. In contrast to non-experts, experts admitted that their patients comply with the rehabilitation protocol to a high extent. This might be explained by the greater authority of more experienced surgeons. Polish experts recommended starting rehabilitation on the day of surgery. Surgeons from all over the world have increasingly emphasized early mobilization, which may produce favourable postoperative outcomes [33,34,35]. Most surgeons (92%) reported that they always recommended that their patient undergo rehabilitation with a physiotherapist after knee arthroscopy, which is now considered the gold standard, and its effectiveness has been shown by a number of control studies [36,37,38,39]. Expert surgeons did not use physical therapists as much as non-experts in making a decision regarding returning to activity. This may be due to newer surgeons being more conservative, relying on physical therapists for another opinion. Evidence-based medicine (EBM) does not exist in physical therapy, in contrast to physiotherapy. In this survey, experts and non-experts recommended physical therapy less frequently (65%) than rehabilitation with a physiotherapist (92%). More research is needed, and consensus should be determined by the Polish National Health Fund in terms of the recommendations of physical therapy after knee arthroscopy.
There is a lack of consensus regarding the optimal postoperative protocol following meniscus repair . Diverse treatment methods require individual and various rehabilitation approaches, which is why direct cooperation between the physiotherapist and the patient is so important . Only 42% of Polish surgeons recommend standardized rehabilitation, and 86% confirm the dependence of the rehabilitation programme on the performed procedure. Additional studies are needed to better clarify the interplay among the tear type, repair method and optimal rehabilitation protocol.
Magnetic resonance imaging (MRI) is considered to be the most accurate method for imaging the internal knee joint structure, with sensitivities in detecting medial meniscus lesions ranging from 83% to 94% [41,42,43]. The ESSKA meniscus consensus group recommended MRI when arthroscopy is considered to identify concomitant pathologies . Magnetic resonance as a diagnostic test for meniscus damage was recommended by 97% of orthopaedists in this study. However, 50% of surgeons recommended ultrasound as a diagnostic method, which should not be practised according to the ESSKA meniscus consensus for traumatic or degenerative damage. Experts and non-experts should be educated on this.
Surgical expertise was significantly associated with the performance of the reconstructive procedures in comparison to diagnostic arthroscopy, which was performed more often by non-experts. Experts were significantly more likely to perform meniscus suture procedures than non-experts, as these procedures are considered advanced and challenging techniques. The clinical experience of participating in this survey of orthopaedists was correlated with the use of newly established methods. Experts were deciding to use bone marrow cells, biomaterials or autologous adipose tissue as meniscus repair methods. All of these approaches that involve the use of cells and biomaterial scaffolds have recently gained increasing attention as potential regenerative therapies in the field of musculoskeletal medicine . Therefore, the observation that non-experts are less frequently choosing these options could be explained by their limited experience with new therapeutic options for patients, as they are still gaining experience with traditional meniscus treatment methods.
Non-expert surgeons were less likely to use objective physical tests, recommended a longer period from meniscus suture to full-range knee motion and admitted that patient age does matter for meniscus repair qualification. All of these issues might be correlated with less experience.
Both experts and non-experts preferred to suture traumatic meniscus tears in 18-year-old and 30-year-old football players. This proves the willingness of meniscus repair and awareness of its role in knee arthritis prevention.
An obvious strength of the study is that it was the first such developed survey study among Polish Arthroscopy Society members. This study had limitations. The questionnaire included 35 questions, which is a prominent number and could cause potential weariness and careless or ill-considered answers. However, during the pilot study, the average time for completion did not exceed 10 minutes, and it would be difficult to collect detailed information about the postoperative aspects of care with fewer questions. Defining the level of expertise at a cut-off level of more than 100 arthroscopies performed per year could be considered a biased decision for this study. Further studies are required to demonstrate clinical comparisons or second-look arthroscopy outcomes.