Health-economic evaluation of meniscus tear treatments: a systematic review.

PURPOSE: To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment. METHODS: Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable. RESULTS: Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures. CONCLUSION: Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale. LEVEL OF EVIDENCE: Systematic review of level IV studies.

"Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review".

PURPOSE: To systematically review the literature on health-economic evaluations of anterior cruciate ligament (ACL) injury between reconstruction surgery (ACLR) and non-operative treatment (NO) and suggest the most cost-effective strategy between the two. METHODS: All economic studies related to ACLR versus NO post-ACL injury, either trial based or model based, published until April 2022, were identified using PubMed and Embase. The methodology of the health-economic analysis for each included study was categorized according to the four approaches: cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), and cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. RESULTS: Of the seven included studies, two compared the strategies of early ACLR and NO alone, and five compared early ACLR and NO with optional delayed ACLR. All studies performed a CUA, and one study performed a CBA additionally. The CHEC scores of the included studies can be considered good, ranging from 15 to 18 from a maximum of 19. Applying the common standard threshold of $50,000 per QALY, six studies in young people with high-activity levels or athletes showed that early ACLR would be preferred over either NO alone or delayed ACLR. Of six studies, two even showed early ACLR to be the dominant strategy over either NO alone or delayed ACLR, with per-patient cost savings of $5,164 and $1,803 and incremental per-patient QALY gains of 0.18 and 0.28, respectively. The one study in the middle-aged people with a moderate activity level showed that early ACLR was not more cost-effective than delayed ACLR, with ICER $101,939/QALY using the societal perspective and ICER $63,188/QALY using the healthcare system perspective. CONCLUSION: Early ACLR is likely the more cost-effective strategy for ACL injury cases in athletes and young populations with high-activity levels. On the other hand, non-operative treatment with optional delayed ACLR may be the more cost-effective strategy in the middle age population with moderate activity levels. LEVEL OF EVIDENCE: Systematic review of level III studies.

Cross-Cultural Adaptation and Measurement Properties of the Indonesian Kujala Score for Anterior Cruciate Ligament Tear Patients.

Introduction: There is an overwhelming need for worldwide applicable subjective grading systems for patients' anterior cruciate ligament (ACL) tear. The scoring system should be validated for their use in advance related measurements. For the Indonesian language speaking population, only the Kujala Patellofemoral Score (KPS) questionnaire has been translated and validated into the Indonesian language for diseases related to knee pain, but none for ACL tears. The present study aims at cross-cultural adaption to measure the validity and reliability of the Kujala patellofemoral score Indonesian version (KPS-I) specifically for ACL tear patients. Material and methods: The responses of 106 ACL tear patients on two questionnaires comprising the KPS-I and Short Form (SF)-36 were examined by determining the validity and reliability. We conducted the validity construct and content, so the reliability was evaluated by test-retest reliability, internal consistency and measurement error. In addition, the research utilised the Bland and Altman method to explore absolute agreement. Results: The construct and content validity were good, where all hypotheses were confirmed, and the floor or ceiling effect did not occur. The reliability proved excellent between test and retest (ICC=0.99). An internal consistency showed a good Cronbach α of 0.86. The standard error of measurement (SEM), minimal detectable change at the individual (MDCind), and minimal detectable change at the group (MDCgrp) were determined to be 2.1, 5.8, and 0.7, respectively. The application of the Bland and Altman plot method revealed no bias in this study. Conclusion: The validation procedure shows that the KPS-I is a good evaluation instrument for Indonesian patients with ACL tear. However, it is suggested that this score be used for follow-up of patients after ACL reconstruction procedure, especially with anterior knee pain related to the original objective of the Kujala score.

Genicular nerve radiofrequency ablation for pain control following anterior cruciate ligament reconstruction - A case report.

Adequate postoperative pain control is an essential factor for the success of rehabilitation programs after anterior cruciate ligament reconstruction (ACLR). The genicular nerve radiofrequency ablation (GNRF) is a recently developed method.This study aimed to evaluate the use of GNRF in patients who underwent ACLR.We performed GNRF guided by ultrasonography for patients who underwent ACLR with aggravated pain. GNRF was performed following ACLR a day after surgery. The pain was evaluated using the Visual Analogue Scale (VAS), and the Euroqol-5 Dimension (EQ-5D) measured the quality of life on the day of one, three, and seven after surgery. Results: In this study, two patients participated. In the postoperative days first, third, and seventh, the mean VAS was decreased after providing the intervention (from 8 to 5, 2, and 1, respectively). The mean EQ5D improved from 0.48 to 0.52, 0.56, 0.66, respectively.We concluded that GNRF is an adequate and safe procedure for managing postoperative pain after ACLR. It may enhance the postoperative rehabilitation program.

Cross-Cultural Adaptation and Measurement Properties of the Indonesian Kujala Score for Anterior Cruciate Ligament Tear Patients

@#Introduction: There is an overwhelming need for worldwide applicable subjective grading systems for patients' anterior cruciate ligament (ACL) tear. The scoring system should be validated for their use in advance related measurements. For the Indonesian language speaking population, only the Kujala Patellofemoral Score (KPS) questionnaire has been translated and validated into the Indonesian language for diseases related to knee pain, but none for ACL tears. The present study aims at cross-cultural adaption to measure the validity and reliability of the Kujala patellofemoral score Indonesian version (KPS-I) specifically for ACL tear patients. Material and methods: The responses of 106 ACL tear patients on two questionnaires comprising the KPS-I and Short Form (SF)–36 were examined by determining the validity and reliability. We conducted the validity construct and content, so the reliability was evaluated by test-retest reliability, internal consistency and measurement error. In addition, the research utilised the Bland and Altman method to explore absolute agreement. Results: The construct and content validity were good, where all hypotheses were confirmed, and the floor or ceiling effect did not occur. The reliability proved excellent between test and retest (ICC=0.99). An internal consistency showed a good Cronbach α of 0.86. The standard error of measurement (SEM), minimal detectable change at the individual (MDCind), and minimal detectable change at the group (MDCgrp) were determined to be 2.1, 5.8, and 0.7, respectively. The application of the Bland and Altman plot method revealed no bias in this study. Conclusion: The validation procedure shows that the KPS-I is a good evaluation instrument for Indonesian patients with ACL tear. However, it is suggested that this score be used for follow-up of patients after ACL reconstruction procedure, especially with anterior knee pain related to the original objective of the Kujala score.