The Demographic and Geographic Trends of Meniscal Procedures in New York State

Abstract

Background: The purpose of this study was to examine the geographic and demographic variations and time trends of different types of meniscal procedures in New York State to determine whether disparities exist in access to treatment. Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) outpatient database was reviewed to identify patients who underwent elective, primary knee arthroscopy between January 1, 2003, and December 31, 2015, for 1 of the following diagnosis-related categories: Group 1, meniscectomy; Group 2, meniscal repair; and Group 3, meniscal allograft transplantation, with or without anterior cruciate ligament reconstruction (ACLR). The 3 groups of meniscal procedures were compared on geographic distribution, patient age, insurance, concomitant ACLR, and surgeon and hospital volume over the study period. Results: A total of 649,470 patients who underwent knee arthroscopy between 2003 and 2015 were identified for analysis. Both meniscectomies and meniscal repairs had a scattered distribution throughout New York State, with allograft volume concentrated at urban academic hospitals. The majority of patients who underwent any meniscal procedure had private insurance, with Medicaid patients having the lowest rates of meniscal surgery. At high-volume hospitals, meniscal repairs and allografts are being performed with increasing frequency, especially in patients <25 years of age. Meniscal repairs are being performed concomitantly with ACLR with increasing frequency. Conclusions: Meniscal repairs and allografts are being performed at high-volume hospitals for privately insured patients with increasing frequency. Geographic access to these treatments, particularly allografts, is limited. Clinical Relevance: Disparities in the availability of advanced meniscal treatment require further investigation and understanding to improve access to care.

Long-term National Trends of Arthroscopic Meniscal Repair and Debridement

“…Rural areas across the United States could potentially lag behind larger, metropolitan areas. 46 However, all regions across the United States demonstrated similarly consistent trends away from meniscectomy, with the exception of the Northwest (Figure 3). This observed difference is possibly attributable to the relatively lower case volume seen in the Northwest compared with other regions, thus making case trends more difficult to establish.…”

“…This added understanding of meniscal function, advancement of repair techniques, recognition of meniscal root tears and meniscocapsular separation, and evidence that some tears have more ability to heal than initially believed, have led to more interest in meniscal preservation procedures. 19,23,31,38,46 The combination of these 2 shifts in approach to meniscal pathology should be seen in the practice patterns of recently trained orthopaedic surgeons. Parker et al, 39 in 2016, demonstrated an increase in meniscal repair among sports fellowship-trained surgeons.…”

Analysis of Charges and Payments for Outpatient Arthroscopic Meniscectomy From 2005 to 2014: Hospital Reimbursement Increased Steadily as Surgeon Payments Declined

“… 33 Meniscal repairs have increased significantly over the past 10 years because repair techniques have improved and because meniscal repair better preserves the knee joint compared with meniscectomy in appropriately selected patients. 26 , 31 …”

Opioid Use After Common Sports Medicine Procedures: A Systematic Review

“…7,15,28,29,51 Knee arthroscopy and related procedures such as anterior cruciate ligament reconstruction (ACLR), meniscal repair, and partial meniscectomy have also continued to grow in volume. 22,23,25,32,36,40,50,60 Despite the growing use of knee, shoulder, and hip arthroscopy, there is a paucity of information regarding postoperative opioid prescribing patterns and use after arthroscopic procedures. This systematic review aims to examine and summarize the trends in prescribing practices and postoperative opioid consumption among patients undergoing sports medicine procedures.…”