The Cost-Effectiveness of Meniscal Repair Versus Partial Meniscectomy in the Setting of Anterior Cruciate Ligament Reconstruction

Lester, Jonathan D.; Gorbaty, Jacob D.; Odum, Susan M.; Rogers, Mark E.; Fleischli, James E.

doi:10.1016/j.arthro.2018.06.046

Cited by 32 publications

(34 citation statements)

References 42 publications

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“…In future and ongoing investigations, the results of the current study may be combined with existing literature on treatment outcomes, surgical and nonoperative success and failure rates, and treatment cost to perform decision analysis studies for OCD treatment in young patients. Similar studies have recently been performed for anterior cruciate ligament surgery, 23,40,41 meniscal surgery, 13,21,22,44 cartilage repair, 10,24,25 and other sports medicine topics. 28 To encourage the widespread use of utility acquisition for HRQoL studies in orthopaedic surgery, standardized guidelines should be developed for the creation of vignettes for utilities acquisition for variable outcome-based conditions.…”

Section: Discussionmentioning

confidence: 63%

Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee

Adjei

Nwachukwu

Zhang

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: The impact of osteochondritis dissecans (OCD) lesions of the knee on a child’s health-related quality of life has not previously been quantified. Preference-based health utility assessment allows patients to assign quality-of-life valuations (utilities) to different health states and conditions. Purpose: To determine (1) patient-reported utility scores for health states associated with pediatric OCD lesions of the knee and (2) whether these scores are associated with patient demographics or disease severity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Children, adolescents, and young adults being treated for OCD of the knee were interviewed to assess utilities for each of the 6 health states commonly encountered in the treatment of OCD: (1) symptomatic lesion, (2) nonoperative rehabilitation, (3) postoperative rehabilitation, (4) intermediate treatment success, (5) early degenerative knee changes, and (6) successful treatment (asymptomatic). Patients were asked to assign health utilities to each state using a standardized feeling thermometer (scale, 0-100), which were converted to a health state utility (scale, 0-1 [1 = perfect health]). Utilities were reported with descriptive statistics, and comparative analyses were performed to test whether assignments were associated with patient age, sex, or whether the OCD lesion required surgical intervention. Results: A total of 100 participants treated or undergoing treatment for OCD were prospectively enrolled; 74% were male (n = 74). The median age at the time of survey was 15 years (interquartile range, 13-16.5 years). Utility scores were as follows: symptomatic OCD lesion, 0.15; nonoperative rehabilitation, 0.30; postoperative rehabilitation, 0.30; early degenerative changes, 0.58; intermediate treatment success, 0.65; and successful treatment, 1.0. Utility scores were not associated with age, sex, or whether the participant underwent surgical treatment for the OCD lesion. Conclusion: The current study quantified patient-reported utilities for 6 OCD lesion health states, which may be used for future health-related quality of life, decision analysis, and quality/safety/value studies. These utility scores were stable and not affected by patient age, sex, or treatment strategy.

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Section: Discussionmentioning

confidence: 63%

Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee

Adjei

Nwachukwu

Zhang

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Some decisions such as whether to repair or debride meniscus tears may influence the costeffectiveness of ACLR. 7 Because of database limitations, the authors only used 6 state databases, raising the possibility of selection bias.…”

Section: See Related Article On Page 1576mentioning

confidence: 99%

Editorial Commentary: Anterior Cruciate Ligament Costs Are Surprising

Brand¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Given increasing health care costs and clinical equipoise on numerous topics, value calculations are critical. Cost-minimization analysis evaluates throughout a single episode of care. For anterior cruciate ligament reconstruction, this is a reasonable approach given that cost-effectiveness data have been published. Using Healthcare Cost and Utilization Project data, general anesthesia, anesthesia time, greater age, and medical comorbidities were correlated with higher costs. Among the surprising results were increased costs with male gender and Hispanic race. Interestingly, the location of the surgery, surgery center versus hospital, or meniscal repair did not significantly impact costs. This information can be used by physicians for cost comparison and factors that determine costs.

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“…This is where they lost me and appeared to have stepped beyond the scope of their study, given that there is more than an abundance of literature to refute their contention. [11][12][13][14][15] Also concerning is the recommendation of Venjakob et al 5 that absorbable sutures should be used if a meniscal repair were undertaken. If sutures can abrade the overlying cartilage, they reasoned that it may be beneficial to use a suture that disintegrates over time to minimize this exposure.…”

Section: Catch-22?mentioning

confidence: 99%

Editorial Commentary: A Stitch in Time May Save the Meniscus…but Not the Articular Cartilage?

Kurzweil¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Early-generation meniscal fixators sometimes caused iatrogenic articular cartilage damage. This resulted in injury to the very structure one tries to preserve when repairing a meniscal tear. Advances in suture-based meniscal implants and all-inside suture devices have allowed us to safely repair meniscal tears, even ones thought previously irreparable, and without the need for a secondary incision. As the techniques for meniscal repair continue to improve, orthopaedic surgeons should be encouraged to consider repair with more complex meniscal tear patterns.

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The Cost-Effectiveness of Meniscal Repair Versus Partial Meniscectomy in the Setting of Anterior Cruciate Ligament Reconstruction

Cited by 32 publications

References 42 publications

Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee

Health State Utilities in Children and Adolescents With Osteochondritis Dissecans of the Knee

Editorial Commentary: Anterior Cruciate Ligament Costs Are Surprising

Editorial Commentary: A Stitch in Time May Save the Meniscus…but Not the Articular Cartilage?

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