Is the die cast? Anterior cruciate ligament injury and osteoarthritis

Rajput, Vishal; Haddad, Fares S.

doi:10.1302/0301-620x.104b5.bjj-2022-0239

Cited by 10 publications

(8 citation statements)

References 54 publications

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“…In addition, results were calculated over only 18 months, and the potential long-term implications of ACL injury and reconstruction such as post-traumatic OA, revisions, or conversions to total knee arthroplasty and their impact on costs and HRQoL were not captured within the analysis. 7,23 Notwithstanding this, most patients had established their level of instability at 18 months since being included in the trial. Hence, longer follow-up is needed to confirm whether the observed differences in costs and QoL are maintained.…”

Section: Discussionmentioning

confidence: 99%

“…For such a common injury, its current management is based on limited evidence, [1][2][3][4][5] and this has led to a highly varied approach to managing both acute and chronic ACL injury, 6 as well as concerns about post-traumatic osteoarthritis (OA). 7 Non-surgical (rehabilitation) or surgical (reconstruction) treatments are common approaches to managing ACL injury. ACL reconstruction is one of the most frequent knee surgeries worldwide with 30,000 being performed each year in England.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness analysis of a pragmatic randomized trial evaluating surgical reconstruction versus rehabilitation in patients with long-standing anterior cruciate ligament injury

Leal,

Mirza,

Davies

et al. 2024

Bone Joint J

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AimsThe aim of this study was to estimate the incremental use of resources, costs, and quality of life outcomes associated with surgical reconstruction compared to rehabilitation for long-standing anterior cruciate ligament (ACL) injury in the NHS, and to estimate its cost-effectiveness.MethodsA total of 316 patients were recruited and randomly assigned to either surgical reconstruction or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment). Healthcare resource use and health-related quality of life data (EuroQol five-dimension five-level health questionnaire) were collected in the trial at six, 12, and 18 months using self-reported questionnaires and medical records. Using intention-to-treat analysis, differences in costs, and quality-adjusted life years (QALYs) between treatment arms were estimated adjusting for baseline differences and following multiple imputation of missing data. The incremental cost-effectiveness ratio (ICER) was estimated as the difference in costs divided by the difference in QALYs between reconstruction and rehabilitation.ResultsAt 18 months, patients in the surgical reconstruction arm reported higher QALYs (0.052 (95% confidence interval (CI) -0.012 to 0.117); p = 0.177) and higher NHS costs (£1,017 (95% CI 557 to 1,476); p < 0.001) compared to rehabilitation. This resulted in an ICER of £19,346 per QALY with the probability of surgical reconstruction being cost-effective of 51% and 72% at a willingness-to-pay threshold of £20,000 and £30,000 per QALY, respectively.ConclusionSurgical reconstruction as a management strategy for patients with long-standing ACL injury is more effective, but more expensive, at 18 months compared to rehabilitation management. In the UK setting, surgical reconstruction is cost-effective.Cite this article: Bone Joint J 2024;106-B(1):38–45.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of a pragmatic randomized trial evaluating surgical reconstruction versus rehabilitation in patients with long-standing anterior cruciate ligament injury

Leal,

Mirza,

Davies

et al. 2024

Bone Joint J

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“…A lifetime of assessing and treating ACL injuries has taught me that we still struggle to understand the various mechanisms of injury, the subsequent pathophysiology and the kinematics of the knee, the secondary consequences, and the optimal management, including the best timing, the type of repair, reconstruction, or nonoperative management needed, and the ultimate desirable level of activity and its timing and consequences. [5][6][7][8] The greatest success in ACL injury is not going to be a surgical solution, it will be prevention of the insult in the first place. That is particularly key in female athletes.…”

Section: Important Matters That Need Attentionmentioning

confidence: 99%

Important matters that need attention

Haddad

2023

Bone Joint J

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“…[1][2][3][4] Once the ACL is injured, instability often ensues, 5,6 which is postulated to cause secondary damage that increases the rates of meniscal and chondral injuries in chronically deficient knees. 7,8 Chondral injury is a precursor unknown date of tear. Patient characteristics are summarized in Table I.…”

Section: Introductionmentioning

confidence: 99%

“…1-4 Once the ACL is injured, instability often ensues, 5,6 which is postulated to cause secondary damage that increases the rates of meniscal and chondral injuries in chronically deficient knees. 7,8 Chondral injury is a precursor to post-traumatic osteoarthritis (OA), 9-13 which may be preventable. 12 ACL reconstruction (ACLr) aims to restore knee function and stability, thereby preventing secondary damage and the progression to OA.…”

Section: Introductionmentioning

confidence: 99%

Delaying anterior cruciate ligament reconstruction increases the rate and severity of medial chondral injuries

Cance,

Erard,

Shatrov

et al. 2023

Bone Joint J

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AimsThe aim of this study was to evaluate the association between chondral injury and interval from anterior cruciate ligament (ACL) tear to surgical reconstruction (ACLr).MethodsBetween January 2012 and January 2022, 1,840 consecutive ACLrs were performed and included in a single-centre retrospective cohort. Exclusion criteria were partial tears, multiligament knee injuries, prior ipsilateral knee surgery, concomitant unicompartmental knee arthroplasty or high tibial osteotomy, ACL agenesis, and unknown date of tear. A total of 1,317 patients were included in the final analysis, with a median age of 29 years (interquartile range (IQR) 23 to 38). The median preoperative Tegner Activity Score (TAS) was 6 (IQR 6 to 7). Patients were categorized into four groups according to the delay to ACLr: < three months (427; 32%), three to six months (388; 29%), > six to 12 months (248; 19%), and > 12 months (254; 19%). Chondral injury was assessed during arthroscopy using the International Cartilage Regeneration and Joint Preservation Society classification, and its association with delay to ACLr was analyzed using multivariable analysis.ResultsIn the medial compartment, delaying ACLr for more than 12 months was associated with an increased rate (odds ratio (OR) 1.93 (95% confidence interval (CI) 1.27 to 2.95); p = 0.002) and severity (OR 1.23 (95% CI 1.08 to 1.40); p = 0.002) of chondral injuries, compared with < three months, with no association in patients aged > 50 years old. No association was found for shorter delays, but the overall dose-effect analysis was significant for the rate (p = 0.015) and severity (p = 0.026) of medial chondral injuries. Increased TAS was associated with a significantly reduced rate (OR 0.88 (95% CI 0.78 to 0.99); p = 0.036) and severity (OR 0.96 (95% CI 0.92 to 0.99); p = 0.017) of medial chondral injuries. In the lateral compartment, no association was found between delay and chondral injuries.ConclusionDelay was associated with an increased rate and severity of medial chondral injuries in a dose-effect fashion, in particular for delays > 12 months. Younger patients seem to be at higher risk of chondral injury when delaying surgery. The timing of ACLr should be optimally reduced in this population.Cite this article: Bone Joint J 2023;105-B(9):953–960.

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Is the die cast? Anterior cruciate ligament injury and osteoarthritis

Cited by 10 publications

References 54 publications

Cost-effectiveness analysis of a pragmatic randomized trial evaluating surgical reconstruction versus rehabilitation in patients with long-standing anterior cruciate ligament injury

Cost-effectiveness analysis of a pragmatic randomized trial evaluating surgical reconstruction versus rehabilitation in patients with long-standing anterior cruciate ligament injury

Important matters that need attention

Delaying anterior cruciate ligament reconstruction increases the rate and severity of medial chondral injuries

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