Large regional differences in incidence of arthroscopic meniscal procedures in the public and private sector in Denmark

Hare, Kristoffer Borbjerg; Vinther, Jesper Høeg; Lohmander, L. Stefan; Thorlund, Jonas Bloch

doi:10.1136/bmjopen-2014-006659

Cited by 22 publications

(24 citation statements)

References 30 publications

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“…As in the published literature [22][23][24], the most common procedures in our group were meniscal procedures. However, it is well known that partial meniscectomy accelerates cartilage degeneration.…”

Section: Discussionmentioning

confidence: 75%

Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

et al. 2019

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Purpose: This study evaluated the diagnostic accuracy of physical examination and magnetic resonance imaging (MRI) in knee injuries. Methods: Ninety-six patients at a regional hospital were included in the study. Each participant underwent a physical examination in which menisci and ACL were evaluated. Knee joint MRI was collected from each patient. Physical examination and MRI scans were then compared with knee arthroscopy findings as a golden standard for meniscal and ligamentous lesions. The data were analyzed and specificity and sensitivity were calculated and correlated on receiver operating characteristics (ROC) curves. Results: Knee arthroscopy diagnosed 32 total ACL ruptures, 45 medial meniscus and 17 lateral meniscus lesions. Three patients were diagnosed with bilateral meniscal lesions. The highest sensitivities were the McMurray test (87.5%) for medial meniscus (MM) and the Thessaly test (70%) for lateral meniscus (LM). The most sensitive ACL test was Lachman (84.5%), whereas, the pivot shift and Lelli tests were the most specific (98.5%). MRI was highly sensitive for MM (96%) with specificity of 52%. MRI showed lower sensitivity (70%) and higher specificity (85.5%) for LM. The specificity of MRI for ACL rupture was 92%, with sensitivity only 75%. Conclusion: McMurray and Apley tests for meniscal lesions seem the most appropriate in daily practice. A combination of lever signs, pivot shifts (PSs) and Lachman tests showed the best sensitivity and specificity in detecting ACL deficiency, and was superior to MRI.

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Section: Discussionmentioning

confidence: 75%

Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

et al. 2019

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“…Most recently, Thorlund et al (2014) from Denmark reported that the incidence of meniscus surgery had doubled from 2000 to 2011 (the annual incidence increased from 164 to 312 per 10 5 person-years). Furthermore, in their other study the increase in incidence was seen especially in the private sector (Hare et al 2015). In addition, quite remarkably, the incidence increased 3-fold in patients over 55 years of age (Thorlund et al 2014).…”

Section: Discussionmentioning

confidence: 81%

“…Geographical variations in surgical procedures result mainly from differences in physician beliefs about the indications for surgery, and the extent to which patient preferences are incorporated into treatment decisions, while a smaller degree of variation in regional surgery rates is due to differences in illness burden, diagnostic practices, and patient attitudes (Birkmeyer et al 2013, Hare et al 2015). Financial incentives also influence the practice patterns of physicians (Mitchell 2010, Hare et al 2015). In addition, the number of knee MRIs and knee arthroscopies performed appears to be correlated (Hare et al 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Financial incentives also influence the practice patterns of physicians (Mitchell 2010, Hare et al 2015). In addition, the number of knee MRIs and knee arthroscopies performed appears to be correlated (Hare et al 2015). A recent Danish study revealed that the incidence of meniscus surgery in Denmark is twice as high as that in Finland, and 6 times higher than that in Sweden (Thorlund et al 2014).…”

Section: Discussionmentioning

confidence: 99%

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Changes in rates of arthroscopy due to degenerative knee disease and traumatic meniscal tears in Finland and Sweden

et al. 2015

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Background and purposeKnee arthroscopy is commonly performed to treat degenerative knee disease symptoms and traumatic meniscal tears. We evaluated whether the recent high-quality randomized control trials not favoring arthroscopic surgery for degenerative knee disease affected the procedure incidence and trends in Finland and Sweden.Patients and methodsWe conducted a bi-national registry-based study including all adult (aged ≥18 years) inpatient and outpatient arthroscopic surgeries performed for degenerative knee disease (osteoarthritis (OA) and degenerative meniscal tears) and traumatic meniscal tears in Finland between 1997 and 2012, and in Sweden between 2001 and 2012.ResultsIn Finland, the annual number of operations was 16,389 in 1997, reached 20,432 in 2007, and declined to 15,018 in 2012. In Sweden, the number of operations was 9,944 in 2001, reached 11,711 in 2008, and declined to 8,114 in 2012. The knee arthroscopy incidence for OA was 124 per 105 person-years in 2012 in Finland and it was 51 in Sweden. The incidence of knee arthroscopies for meniscal tears coded as traumatic steadily increased in Finland from 64 per 105 person-years in 1997 to 97 per 105 person-years in 2012, but not in Sweden.InterpretationThe incidence of arthroscopies for degenerative knee disease declined after 2008 in both countries. Remarkably, the incidence of arthroscopy for degenerative knee disease and traumatic meniscal tears is 2 to 4 times higher in Finland than in Sweden. Efficient implementation of new high-quality evidence in clinical practice could reduce the number of ineffective surgeries.

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“…These findings suggest this increase in procedures mainly impacts patients with degenerative lesions. In another Danish study, Hare et al [16] reported an increase in the rate of arthroscopic meniscus surgery (repair and meniscectomy) in public and private hospitals between 2000 and 2011. The increase was especially noticeable in the private sector, where the proportion of arthroscopic meniscus surgery went from 1% to 32% during this period.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the trends in arthroscopic meniscectomy and meniscus repair procedures in France from 2005 to 2017

Jacquet¹,

Pujol²,

Pauly³

et al. 2019

Orthopaedics & Traumatology: Surgery & Research

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Introduction: In 2008, the French National Authority for Health (HAS) recommended that "conservative" treatments be adopted for meniscal lesions. This recommendation and the lack of superiority of meniscectomy over non-operative treatment for meniscus degeneration have modified the treatment pathway. However, the impact of these findings on French clinical practice is not known. The objective of this study was to evaluate the change over time in the number of alternative surgical procedures (meniscectomy and meniscus repair) and regional variation in France using data from the French agency for information on hospital care (ATIH). Hypothesis: We hypothesized that the number of meniscectomy procedures will decrease, and the number of repair procedures will increase over time at various healthcare facilities. Patients and methods: Between 2005 and 2017, the number of hospitalizations in the Medicine-Surgery-Obstetrics wards for meniscectomy (NFFC003 and NFCC004) or meniscus repair (NFEC001 and NFEC002) was evaluated overall and then based on whether the stay occurred in public or private sector hospitals in France. Data were extracted from the ATIH database and the findings were (1) related to French demographics during the period in question; (2) separated into public or private sector hospitals; (3) distributed into various regions in France and; (4) stratified by patient age. Results: Between 2005 and 2017, 1,564,461 meniscectomy and 63,142 meniscus repair procedures were done in France. Over this period in the entire country, the meniscectomy rate gradually decreased from 19.80/10,000 inhabitants in 2005 to 15.77/10,000 inhabitants in 2017 (21.4% reduction) (p < 0.0001) while the meniscus repair rate increased from 0.42/10,000 inhabitants in 2005 to 1.36/10,000 inhabitants in 2017 (320% increase) (p < 0.0001). The largest meniscectomy reduction effort occurred in private sector hospitals, going from 15.79 to 12.01/10,000 inhabitants in 12 years; the decrease was smaller in public hospitals (going from 4.01 to 3.77/10,000 inhabitants) (p < 0.0001 in both cases). The change in the procedure ratio between private and public hospitals was asymmetric, with the meniscus repair/meniscectomy ratio clearly increasing more in public hospitals (4% to 12.6%) between 2005 and 2017 than in private hospitals (1.6% to 6.6%) (p < 0.0001). We found large regional differences: regions in Eastern France had higher meniscectomy rates, while regions in Western France had higher meniscus repair rates. When the analysis of procedures between 2008 and 2017 was stratified by age, a similar increase in repair procedures was found in all age brackets. Conversely, the reduction in meniscectomy was most apparent before 40 years of age, and the number of meniscectomy procedures was stable after 60 years of age. Conclusion: These findings suggest there has been a significant shift in the surgical management of meniscal injuries towards more conservative treatments. But the large variations between regions in France is evidence of a continued ...

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Large regional differences in incidence of arthroscopic meniscal procedures in the public and private sector in Denmark

Cited by 22 publications

References 30 publications

Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

Changes in rates of arthroscopy due to degenerative knee disease and traumatic meniscal tears in Finland and Sweden

Analysis of the trends in arthroscopic meniscectomy and meniscus repair procedures in France from 2005 to 2017

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