Study quantifies impact of ACL reconstruction vs rehabilitation

A cost-utility analysis recently published in the Journal of Bone and Joint Surgery that compared structured rehabilitation alone to ACL reconstruction indicated that reconstruction saved society $50,417 per patient and gained patients 0.72 quality-adjusted life years incrementally.

"This is the first study to demonstrate the importance of a societal perspective when considering the costs and benefits of anterior cruciate ligament repair and policies that will affect access to this procedure," Lane Koenig, PhD, study author and president of KNG Health Consulting LLC, Rockville, Md., stated in a press release from the American Academy of Orthopaedic Surgeons. "The benefit of ACL reconstruction has long been known by patients who have returned to their active lifestyle following the surgery. This study provides a foundation for assessing the societal benefits of procedures and health services that will add to the conversation people are having about improved, cost-conscious health care."

Koenig and colleagues gathered data from the Knee Anterior Cruciate Ligament Nonsurgical Versus Surgical Treatment (KANON) study, Multicenter Orthopaedic Outcomes Network (MOON) database and long-term outcomes from the literature, and then applied the data using a Markov decision model to assess the societal costs of ACL reconstruction and rehabilitation. Costs included the impact of the injury on earnings, disability and work status, while the efficacy of treatment was measured by quality of life years gained. According to the study, there were 988 primary ACL tears in the KANON database with a mean follow-up of 6 years. The MOON database included 121 patients with a mean follow-up of 2 years.

The mean lifetime cost to society of ACL reconstruction was $38,121 compared to $88,538 for rehabilitation. The researchers found the cost to society for ACL reconstruction was $7.6 billion annually vs. $17.7 billion annually for rehabilitation.

The researchers estimated that if all patients were treated with ACL reconstruction, 118,000 would develop radiographic osteoarthritis, 31,600 would develop symptomatic osteoarthritis and 25,800 would need total knee arthroplasties (TKAs). If patients were treated with rehabilitation, 140,000 would develop radiographic osteoarthritis, 38,000 would develop symptomatic osteoarthritis and 30,800 would require TKAs.

"In younger patients, surgery for an ACL tear is the best option for getting them back on their feet and reducing the likelihood of arthritis down the road," study author Mininder S. Kocher, MD, of Boston Children’s Hospital Division of Sports Medicine, Mass., stated in the press release. "Patients and families are often worried about their ability to return to sports, their mobility in the future and the cost of the surgery. This study sheds light on all three of these important factors."

Reference:

Mather R. J Bone Joint Surg. 2013;doi:10.2106/JBJS.L01705.

Disclosures: Kocher and Koenig have no relevant financial disclosures.