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. 2013 Oct 2;95(19):1751-9.
doi: 10.2106/JBJS.L.01705.

Societal and economic impact of anterior cruciate ligament tears

Richard C Mather 3rd  1 , Lane Koenig, Mininder S Kocher, Timothy M Dall, Paul Gallo, Daniel J Scott, Bernard R Bach Jr, Kurt P Spindler; MOON Knee Group
Affiliations

Societal and economic impact of anterior cruciate ligament tears

Richard C Mather 3rd et al. J Bone Joint Surg Am. .

Abstract

Background: An anterior cruciate ligament (ACL) tear is a common knee injury, particularly among young and active individuals. Little is known, however, about the societal impacts of ACL tears, which could be large given the typical patient age and increased lifetime risk of knee osteoarthritis. This study evaluates the cost-effectiveness of ACL reconstruction compared with structured rehabilitation only.

Methods: A cost-utility analysis of ACL reconstruction compared with structured rehabilitation only was conducted with use of a Markov decision model over two time horizons: the short to intermediate term (six years), on the basis of Level-I evidence derived from the KANON Study and the Multicenter Orthopaedic Outcomes Network (MOON) database; and the lifetime, on the basis of a comprehensive literature review. Utilities were assessed with use of the SF-6D. Costs (in 2012 U.S. dollars) were estimated from the societal perspective and included the effects of the ACL tear on work status, earnings, and disability. Effectiveness was expressed as quality-adjusted life years (QALYs) gained.

Results: In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a QALY gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation.

Conclusions: ACL reconstruction is the preferred cost-effective treatment strategy for ACL tears and yields reduced societal costs relative to rehabilitation once indirect cost factors, such as work status and earnings, are considered. The cost of an ACL tear over the lifetime of a patient is substantial, and resources should be directed to developing innovations for injury prevention and for altering the natural history of an ACL injury.

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Figures

Fig. 1
Fig. 1
Health state diagram. The diagram demonstrates the clinical pathway of patients within the decision model. Patient health states include either a stable or an unstable knee, and patients can undergo reoperation consisting of meniscal repair, meniscectomy, manipulation under anesthesia, or hardware removal. OA = osteoarthritis.
Fig. 2
Fig. 2
Sensitivity of total cost to age at the time of the initial ACL tear. ACLR = ACL reconstruction.
Fig. 3
Fig. 3
Sensitivity of total cost to the rate of instability after rehabilitation. ACLR = ACL reconstruction.
See this image and copyright information in PMC

References

    1. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am. 2009 Oct;91(10):2321-8 - PubMed
    1. Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med. 2009 Jul;37(7):1434-43 - PubMed
    1. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010 Jul 22;363(4):331-42 - PubMed
    1. Spindler KP, Warren TA, Callison JC, Jr, Secic M, Fleisch SB, Wright RW. Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am. 2005 Aug;87(8):1673-9 - PubMed
    1. Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, Holt HL, Solomon DH, Yelin E, Paltiel AD, Katz JN. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med. 2009 Jun 22;169(12):1113-21; discussion 1121-2 - PMC - PubMed

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