Cost and Treatment Characteristics of Sport-Related Knee Injuries Managed by Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network

Abstract

Context: Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers.

Objective: To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries.

Design: Descriptive study.

Setting: Ninety-five athletic training facilities across 24 states.

Patients or other participants: A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1).

Main outcome measure(s): Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care.

Results: A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit.

Conclusions: Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes.

Keywords: patient care; point of care; quality; value; worth.

Figure 1

Flow diagram for selection of the study cohort. ^a Identified by a injury demographics form submitted to the electronic medical record. ^b Complete patient cases were operationalized as cases that had (1) an injury demographics form, (2) an injury evaluation, (3) daily treatment forms with at least 1 encounter per week for the duration of care, and (4) a discharge form. ^c Outliners were defined as patient cases that exceeded 1.5 times the interquartile range.

Figure 2

Patients cases by sport and sex.

Figure 3

Distribution of duration of care (days) per patient case for sport-related knee injuries under the care of athletic trainers (median = 23, mode = 7, interquartile range = 11–49, range = 1–106 days).

Figure 4

Treatments provided by athletic trainers for sport-related knee injuries.

Figure 5

Distribution of visits per patient case for sport-related knee injuries under the care of athletic trainers (median = 8, mode = 3, interquartile range = 5–14, range = 1–27).

Figure 6

Estimated direct costs of care per patient case for sport-related knee injuries under the care of athletic trainers (mean = $733, median = $564, mode = $160, interquartile range = $267–$1080, range = $0–$2160).