No economic benefit of early knee reconstruction over optional delayed reconstruction for ACL tears: registry enriched randomised controlled trial data

Kiadaliri, Aliasghar Ahmad; Englund, Martin; Lohmander, L. Stefan; Carlsson, Katarina Steen; Frobell, Richard

doi:10.1136/bjsports-2015-095308

Cited by 32 publications

(55 citation statements)

References 24 publications

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“…Nwachukwu et al [ 32 ] evaluated the cost-effectiveness analyses in orthopaedic sports medicine literature and suggested that ACL reconstruction was cost-effective. On the other hand, a recent study published by Kiadiliri et al [ 26 ] found no statistically significant difference in economic value in terms of early ACL reconstruction compared with rehabilitation and ACL reconstruction when needed. They may improve the outcome, but at greater expense and with higher administrative costs, plus lapses in quality [ 2 ].…”

Section: Discussionmentioning

confidence: 95%

Similar cost-utility for double- and single-bundle techniques in ACL reconstruction

Sernert

Hanssoń

2017

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim was to estimate the cost-utility of the DB technique (n = 53) compared with the SB (n = 50) technique 2 years after ACL reconstruction.MethodsOne hundred and five patients with an ACL injury were randomised to either the Double-bundle (DB) or the Single-bundle (SB) technique. One hundred and three patients (SBG n = 50, DBG n = 53) attended the 2-year follow-up examination. The mean age was 27.5 (8.4) years in the SBG and 30.1 (9.1) years in the DBG. The cost per quality-adjusted life years (QALYs) was used as the primary outcome. Direct costs were the cost of health care, in this case outpatient procedures. Indirect costs are costs related to reduce work ability for health reasons. The cost-utility analysis was measured in terms of QALY gained.ResultsThe groups were comparable in terms of clinical outcome. Operating room time was statistically significantly longer in the DBG (p = 0.001), making the direct costs statistically significantly higher in the DBG (p = 0.005). There was no significant difference in QALYs between groups. In the cost-effectiveness plane, the mean difference in costs and QALYs from the trial data using 1000 bootstrap replicates in order to visualise the uncertainty associated with the mean incremental cost-effectiveness ratio (ICER) estimate showed that the ICERs were spread out over all quadrants. The cost-effectiveness acceptability curve showed that there was a 50% probability of the DB being cost-effective at a threshold of Euro 50,000.ConclusionThe principal findings are that the DB is more expensive from a health-care perspective. This suggests that the physician may choose individualised treatment to match the patients’ expectations and requirements.

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Section: Discussionmentioning

confidence: 95%

Similar cost-utility for double- and single-bundle techniques in ACL reconstruction

Sernert

Hanssoń

2017

Knee Surg Sports Traumatol Arthrosc

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“…There is a delicate balance between desirable and undesirable treatment consequences. Costs for ACLR outweighs costs for non-operative treatment, and an early ACLR is not more beneficial in terms of costs, compared to a delayed ACLR 61 . With regard to values and preferences, patients often prefer ACLR, which seems to be founded in beliefs that ACLR is a necessary treatment to allow physical activity 120 .…”

Section: Reasons For Choice Of Treatmentmentioning

confidence: 99%

Treatment Decision after Anterior Cruciate Ligament Injury, and Evaluation of Measurement Properties of a Patient Reported Outcome Measure

Grevnerts

2019

Linköping University Medical Dissertations

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Background: After an ACL injury, treatment aims to restore knee function. Evaluation of treatment progress is important, and adequate measurement methods are necessary. The International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) is a common patient-reported outcome measure (PROM) used after ACL injury. It evaluates symptoms, function and physical activity. The IKDC-SKF had not been translated to Swedish language for use in Swedish clinical and research settings. The measurement properties of the IKDC-SKF had been tested, but no assessment of methodological quality of the studies investigating it, nor compiling of results, was published. Sooner or later after an ACL injury, a treatment decision must be made. Treatment options are either ACL reconstruction (ACLR) plus rehabilitation, or rehabilitation alone. There are guidelines stating that a decision for ACLR should be made if the patient has high activity demands and/or knee joint instability. It is unclear which factors orthopaedic surgeons and physiotherapists prioritise when recommending ACLR. It is also unclear when the decision for treatment is taken, on what grounds, and how treatment decision correlates to patients reported symptoms and function. Aims: The overall aim of this thesis was to evaluate the measurement properties of a patient-reported measure for evaluation of function after ACL injury and treatment, and to overview the treatment decision process after an ACL injury. Methods: A systematic review was conducted to assess the measurement properties of the IKDC-SKF. The IKDC-SKF was translated from English to Swedish, and the Swedish version was tested for reliability, validity, responsiveness and interpretability. A survey study was conducted, where 98 orthopaedic surgeons and 391 physiotherapists rated 21 predefined factors based on importance to the decision for ACLR. Orthopaedic surgeons and physiotherapists rated how important they considered their own and each other's assesments and patient's wishes for treatment decision making. In a prospective cohort study, patients with an ACL injury were followed from within 6 weeks up to 12 months after injury. Data regarding treatment chosen,

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“…Several studies have shown that not all PRP product systems yield similar biologic parameters, where the final PRP injectates vary greatly and have differing effects on tendon cells. [5][6][7] Specifically, Yan et al 8 showed that leukocyte-poor PRP (Lp-PRP) improved Achilles tendon healing and was a preferable option for Achilles tendinopathy compared with leukocyterich PRP (Lr-PRP). Interestingly, in the 3 included randomized controlled trials that reported no benefits of PRP, [9][10][11] an Lr-PRP system (GPS, Zimmer-Biomet, Warsaw, IN; Genesis CS, VetStem, Biopharma, Poway, CA) was used, which is already known to be less effective than Lp-PRP in the treatment of Achilles tendinopathy.…”

mentioning

confidence: 99%

“…Interestingly, in the 3 included randomized controlled trials that reported no benefits of PRP, [9][10][11] an Lr-PRP system (GPS, Zimmer-Biomet, Warsaw, IN; Genesis CS, VetStem, Biopharma, Poway, CA) was used, which is already known to be less effective than Lp-PRP in the treatment of Achilles tendinopathy. 7,8 The single study that used the Lp-PRP system (ACP; Arthrex, Munich, Germany), included in this analysis, reported excellent outcomes in the treatment of Achilles tendinopathy. 12 This finding underscores the difference of effect between Lr-PRP and Lp-PRP in treating Achilles tendinopathy.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Author Response Regarding “The Long-Term Outcome After Early and Late Anterior Cruciate Ligament Reconstruction”

Karikis

Kartus

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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No economic benefit of early knee reconstruction over optional delayed reconstruction for ACL tears: registry enriched randomised controlled trial data

Abstract: ISRCTN84752559.

Cited by 32 publications

References 24 publications

Similar cost-utility for double- and single-bundle techniques in ACL reconstruction

Similar cost-utility for double- and single-bundle techniques in ACL reconstruction

Treatment Decision after Anterior Cruciate Ligament Injury, and Evaluation of Measurement Properties of a Patient Reported Outcome Measure

Author Response Regarding “The Long-Term Outcome After Early and Late Anterior Cruciate Ligament Reconstruction”

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