Effects of preoperative treatment on healthcare utilization and return to work for anterior cruciate ligament injuries: a real-world study using the French healthcare database

Abstract

Objective: To compare healthcare use and the number of days of sickness benefits between people with anterior cruciate ligament (ACL) injury who received physiotherapy before and after ACL reconstruction (ACLR) and those who received physiotherapy after ACLR only. Secondary aim: to measure the association between the volume of preoperative healthcare and post-ACLR recovery.

Methods: Each individual's care pathway was extracted from a section of the French National Health Data System (SNDS) database (province: Pays de La Loire). The database was queried for the codes related to sickness benefits and healthcare utilization, including physiotherapy, medical and paramedical visits and procedures, medication, and medical equipment provided up to six months before and eighteen months after the ACLR. (Registry/number: ClinicalTrials.gov/NCT05737719).

Results: Based on the timing of physiotherapy, two subcohorts were created from the database: 'prehabilitation' (n = 513) for those receiving physiotherapy before and after ACLR; 'no prehabilitation' (n = 630) for those only receiving physiotherapy after ACLR. Before ACLR, healthcare use was higher for the 'prehabilitation' group, including the number of medical visits (3.9 ± 2.3 vs. 3.0 ± 1.9 univariate p < 0.001), analgesia (mild opioids 60.4% vs. 49.8% univariate p < 0.001), dispensing of medical equipment (85.0% vs. 68.9% univariate p < 0.001) and sickness benefit days (52.7 ± 45.6 days vs. 33.2 ± 35.8 days, univariate p < 0.001). After ACLR, the 'prehabilitation' group underwent a higher number of physiotherapy sessions (46.8 ± 21.9 sessions vs 35.8 ± 19.0 sessions, p < 0.001) but had a similar number of sickness benefit days (94.7 ± 77.8 days vs 87.1 ± 69.9 days, p = 0.092). From the multivariate analysis (n = 1143): age, comorbidities, the preoperative number of sickness benefit days, and the number of physiotherapy sessions before ACLR explained 24% of the variance in days of sickness benefits after ACLR.

Conclusion: Prehabilitation was associated with higher healthcare utilization before and after ACLR. Prehabilitation, and other preoperative variables, explained only a part of the number of days of sickness benefits after ACLR.

Keywords: Physiotherapy modalities; anterior cruciate ligament; exercise; knee; patient care management; primary health care.