Nearly $30 million a year would be saved in hospital charges if early rather than delayed ACL (anterior cruciate ligament) reconstruction surgery was performed on pediatric patients by avoiding new knee injuries, according to a research paper presented at the American Orthopaedic Society for Sports Medicine's (AOSSM) 2010 Annual Meeting in Providence, Rhode Island.
The study estimated that more than 7,300 tears to the meniscus and 7,800 cartilage tears in children could be avoided each year in the U.S. by early ACL surgery.
Surgery timing still controversial
"The timing of pediatric and adolescent ACL surgery has historically been controversial," said Theodore J. Ganley, MD, Director of Sports Medicine and Associate Professor at the Children's Hospital of Philadelphia. "The theoretical risks of growth disturbance in younger patients are balanced against the risk of further knee damage related to delaying treatment until closer to skeletal maturity."
The goal of ACL knee surgery is to stabilize the knee allowing patients get back to a healthy, active lifestyle. Long-term, the surgery aims to prevent instability and additional damage to the knee.
Delayed surgery risks permanent injury
A 14-year review of ACL reconstructions presented by the authors at the 2009 AOSSM Annual Meeting revealed a 4 to 11-fold increase in meniscal and cartilage injuries with a greater than 12 week delay in ACL treatment.
In the current study, a model for pediatric ACL reconstruction was developed based on probabilities derived from the 2009 ACL review. Identical groups of 100,000 patients, representative of the U.S. population were simulated to undergo either early or delayed ACL reconstruction, with the secondary meniscal and cartilage damage and hospital charges compared between the two groups.
"The decision tree and statistical modeling approach for the study created by my co-author Suneel Bhat, is unique in that it incorporates variability, thereby generating a model simulation of a large scale prospective study, which provides a way to generalize implications," said Dr. Ganley.
For females, delaying ACL reconstruction beyond 12 weeks results in an estimated 1,560 additional medial meniscal tears and 2,100 cartilage tears each year. For males, delayed surgery resulted in 3,300 medial meniscal tears and 5,720 cartilage tears relative to early surgery.
The study revealed that more than $29.4 million would be saved in hospital charges for pediatric patients each year in the U.S. by reconstructing ACL tears early rather than delaying treatment.
A 2013 study in the Journal of Bone and Joint Surgery  found that ACL reconstruction was less costly (a cost reduction of $4,503) and more effective in terms of quality of life compared with rehabilitation because of the higher probability of an unstable knee associated with rehabilitation.
In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was less than half that for rehabilitation ($38,121 versus $88,538), "demonstrat[ing] that access to ACL reconstruction is critical to optimal societal health-care delivery," the study concluded.
Source: American Orthopaedic Society for Sports Medicine
1. Mather RC. Koenig L, Kocher MS, et al. Societal and Economic Impact of Anterior Cruciate Ligament Tears. J Bone Joint Surg Am 2013;95:1751-9.