Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management

Abstract

Purpose The purpose of this study was to determine the cost of arthroscopic partial meniscectomy (APM), one of the most common surgeries performed by orthopaedic surgeons, and the associated rate of progression to knee arthroplasty (KA) compared to patients treated non‐operatively after diagnosis of meniscal tear. Methods Utilizing data mining software (PearlDiver, Colorado Springs, CO), a national insurance database of approximately 23.5 million orthopaedic patients was queried for patients diagnosed with a meniscal tear. Patients were classified by treatment: non‐operative and arthroscopic partial meniscectomy and were followed after initial diagnosis for cost and progression to knee arthroplasty. Results There were 176,407 subjects in the non‐op group and 114,194 subjects in the arthroscopic partial meniscectomy group. Arthroscopic partial meniscectomy generated more cost than non‐operative ($3842.57 versus $411.05, P < 0.001). Arthroscopic partial meniscectomy demonstrated greater propensity to need future knee arthroplasty (11.4% at 676 days) than those treated non‐operatively (9.5% at 402 days) (P < 0.001). Female patients demonstrated a higher rate of progression to knee arthroplasty in the arthroscopic partial meniscectomy and non‐operative groups (P < 0.001). Conclusion Compared to non‐operative treatment for meniscal tears, arthroscopic partial meniscectomy is more expensive and does not appear to decrease the rate of progression to knee arthroplasty. Patients undergoing arthroscopic partial meniscectomy yielded on average a delay of only 9 months (274 days) before undergoing knee arthroplasty. Female patients experienced a significantly higher rate of progression to knee arthroplasty. The authors recognize the limitations of this type of study including its retrospective nature, reliance upon accurate coding and billing information, and the inability to determine whether symptoms including mechanical locking played a role in the decision to perform an APM. Level of evidence IV.

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

“…The increased rate of knee arthroplasty after meniscectomy further confirms the results of previous studies, with up to 51.5% of patients requiring knee arthroplasty after meniscectomy compared with 33.5% after meniscal repair at the 10-year follow-up. 1,5,13,29 Abram et al 1 utilized the National Health Service database of England to determine that 0.67% of patients who underwent meniscectomy between the ages of 20 and 39 years required subsequent knee arthroplasty. This is similar to the current study, with 1.5% requiring total knee arthroplasty in similar aged patients with similar follow-up.…”

“…This leads to a relatively low incidence of knee arthroplasty compared with older patients undergoing meniscectomy or meniscal repair in other studies. 1,5,13,29…”

“…This leads to a relatively low incidence of knee arthroplasty compared with older patients undergoing meniscectomy or meniscal repair in other studies. 1,5,13,29 There are some limitations to this study that are inherent to all studies that use large databases. The analysis is dependent upon the accuracy of the ICD and CPT codes reported.…”

Rates and Risk Factors of Revision Arthroscopy or Conversion to Total Knee Arthroplasty Within 1 Year Following Isolated Meniscectomy

“… 35 Approximately 10% of patients undergoing meniscectomy require a TKA within 1 year of the initial meniscectomy. 36 , 37 Barnds et al. demonstrated that arthroscopic partial meniscectomy survived 9 months before patients received TKA.…”

“…demonstrated that arthroscopic partial meniscectomy survived 9 months before patients received TKA. 36 In younger, more active patients with persistent symptoms following meniscectomy, surgeons may offer patients revision arthroscopy or other interventions, such as meniscal scaffolds, meniscal allograft transplantation or, in the case of advanced osteoarthritis, off-loading osteotomies or joint replacement. 38 Surgeons may be reluctant to offer TKA to younger patients because they face the risk of revision TKA at a younger age as well as the potential for multiple revision arthroplasties.…”