Acute reconstruction results in less sick-leave days and as such fewer indirect costs to the individual and society compared to delayed reconstruction for ACL injuries

Abstract

Purpose To compare the total number of sick-leave days caused by the knee injury from the day of injury and over the first year between acute (within 8 days) and delayed (6-10 weeks) anterior cruciate ligament reconstruction (ACLR) and also assess other clinical outcomes during this period. Methods Seventy patients with an acute ACL injury and Tegner level of 6 or more were randomized to acute (within 8 days) or delayed (after 6-10 weeks) ACLR. Patient-reported outcomes; objective IKDC and manual stability measurements were assessed at 6 and 12 months. With data from the Swedish Social Insurance Agency (Försäkringskassan) information about the number of sick-leave days due to the knee injury over the following 12 months was collected and compared between the two groups. Results Seventy-one percent received compensation for sick leave (26 in the acute versus 23 in the delayed group). The mean number of sick-leave days for the acute group was significantly lower (M = 56.9, SD = 36.4) compared to the delayed group (M = 88.5, SD = 50.2), p < 0.05. The acute group was also significantly stronger in flexion in both slow and fast angle velocities according to Biodex ®. No other differences were found between the groups in other clinical assessments or in terms of associated injuries. Conclusion Acute and delayed ACLR provided comparable clinical outcomes after 12 months. Acute reconstruction resulted in less sick-leave days and as such fewer indirect costs to the individual and society. These findings suggest that if patients requiring ACLR can be identified early and ACLR can be performed in the acute phase, socioeconomic costs can potentially be reduced by minimizing time off work. Level of evidence II.

Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis

“…This suggests early surgery, before recurring giving ways have occurred, decreases additional injuries, and increases the likelihood of FR. Finally, it should be mentioned that an acute ACLR has been shown to be more cost-effective than delayed surgery, and time spent on rehabilitation before the surgery is better utilized postoperatively [ 23 , 27 , 36 ].…”

ACL reconstruction for all is not cost-effective after acute ACL rupture

“…Also we might be more reserved with an early ACL reconstruction in younger patients, because young and active patients have the highest risk of a new knee injury possibly and the young might be helped more in the long run with adjustment of their activity level. 8 Von Essen et al 13 found that acute reconstruction resulted in less sick-leave days and fewer indirect costs to the individual and society and was cost-effective. But they did not take into account that 50% of patients treated with a rehabilitation programme are doing well with this treatment and were not reconstructed after all.…”

“…Several studies have been published on the costs of ACL reconstruction with different grafts and with a decision-tree analysis for competitive athletes, but so far not with the use of real patient-data of a randomised controlled trial. [11][12][13] The aim of this study was to evaluate the cost-utility of early ACL reconstruction (index) versus rehabilitation plus an optional reconstruction after acute ACL rupture (comparator) with the use of data of a randomised controlled trial.…”

The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

“…16 Treating these patients nonoperatively also increases the time from injury to return to sports, as their time from injury to surgery increases, and increases the indirect costs by requiring longer sick leave time. 27…”

“…16 Treating these patients nonoperatively also increases the time from injury to return to sports, as their time from injury to surgery increases, and increases the indirect costs by requiring longer sick leave time. 27 When reviewing these advantages and disadvantages, there does not seem to be one clear strategy for all patients, and treatment may depend on individual patient characteristics. It is important to assess the role of these individual patient characteristics in the success of nonoperative ACL treatment to advise patients to either start nonoperative treatment with optional delayed ACL surgery, and potentially avoid surgery, or perform early ACL surgery and potentially avoid meniscal and chondral injury and have shorter time from injury to surgery.…”