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Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management

  • Brandon BarndsEmail author
  • Brandon Morris
  • Scott Mullen
  • John Paul Schroeppel
  • Armin Tarakemeh
  • Bryan G. Vopat
KNEE

Abstract

Purpose

The purpose of this study was to determine the cost of arthroscopic partial meniscectomy (APM), one of the most common surgeries performed by orthopaedic surgeons, and the associated rate of progression to knee arthroplasty (KA) compared to patients treated non-operatively after diagnosis of meniscal tear.

Methods

Utilizing data mining software (PearlDiver, Colorado Springs, CO), a national insurance database of approximately 23.5 million orthopaedic patients was queried for patients diagnosed with a meniscal tear. Patients were classified by treatment: non-operative and arthroscopic partial meniscectomy and were followed after initial diagnosis for cost and progression to knee arthroplasty.

Results

There were 176,407 subjects in the non-op group and 114,194 subjects in the arthroscopic partial meniscectomy group. Arthroscopic partial meniscectomy generated more cost than non-operative ($3842.57 versus $411.05, P < 0.001). Arthroscopic partial meniscectomy demonstrated greater propensity to need future knee arthroplasty (11.4% at 676 days) than those treated non-operatively (9.5% at 402 days) (P < 0.001). Female patients demonstrated a higher rate of progression to knee arthroplasty in the arthroscopic partial meniscectomy and non-operative groups (P < 0.001).

Conclusion

Compared to non-operative treatment for meniscal tears, arthroscopic partial meniscectomy is more expensive and does not appear to decrease the rate of progression to knee arthroplasty. Patients undergoing arthroscopic partial meniscectomy yielded on average a delay of only 9 months (274 days) before undergoing knee arthroplasty. Female patients experienced a significantly higher rate of progression to knee arthroplasty. The authors recognize the limitations of this type of study including its retrospective nature, reliance upon accurate coding and billing information, and the inability to determine whether symptoms including mechanical locking played a role in the decision to perform an APM.

Level of evidence

IV.

Keywords

Meniscal tear Meniscectomy Knee arthroscopy Knee Total knee replacement Total knee arthroplasty 

Abbreviations

OA

Knee osteoarthritis

BMI

Body mass index

PT

Physical therapy

APM

Arthroscopic partial meniscectomies

ICD

International classification of diseases

CPT

Current procedural terminology

TKA

Total knee arthroplasties

KA

Knee arthroplasty

RCT

Randomized controlled trial

Notes

Author contributions

BB: primary author and orthopaedic resident responsible for all aspects of study and manuscript. BM: co-author and orthopaedic resident responsible for background, study design, analysis, and review. AT: co-author and orthopaedic research assistant responsible for database management, analysis, and review. JPS: co-author and orthopaedic attending responsible for background, study design, analysis, and review. SM: co-author and orthopaedic attending responsible for background, study design, analysis, and review. BV: primary investigator and orthopaedic attending responsible for background, study design, analysis, and review.

Funding

Funding was provided by the Department of Orthopedics at The University of Kansas Medical Center, no outside funding was used.

Compliance with ethical standards

Conflict of interest

None of the authors have any relevant conflicts of interest pertaining to this research.

Ethical approval

This study was approved by the Institutional Review Board at The University of Kansas Medical Center.

Supplementary material

167_2019_5481_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 25 KB)
167_2019_5481_MOESM2_ESM.tif (23 kb)
Supplemental Figure 1: Kaplan-Meier survival analysis illustrating the ratio of patients within each treatment group that did not require KA, and the number of days since initial diagnosis of meniscal tear to KA. (TIF 23 KB)

References

  1. 1.
    Baratz ME, Fu FH, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 14(4):270–275CrossRefGoogle Scholar
  2. 2.
    Brophy RH, Gray BL, Nunley RM, Barrack RL, Clohisy JC (2014) Total knee arthroplasty after previous knee surgery: expected interval and the effect on patient age. J Bone Jt Surg Am 96(10):801–805CrossRefGoogle Scholar
  3. 3.
    Englund M, Lohmander LS (2004) Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50(9):2811–2819CrossRefGoogle Scholar
  4. 4.
    Englund M, Roos EM, Roos HP, Lohmander LS (2001) Patient-relevant outcomes fourteen years after meniscectomy: influence of type of meniscal tear and size of resection. Rheumatology (Oxford) 40(6):631–639CrossRefGoogle Scholar
  5. 5.
    Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Jt Surg Br Vol 30(4):664–670CrossRefGoogle Scholar
  6. 6.
    Feeley BT, Liu S, Garner AM, Zhang AL, Pietzsch JB (2016) The cost-effectiveness of meniscal repair versus partial meniscectomy: a model-based projection for the United States. Knee 23(4):674–680CrossRefGoogle Scholar
  7. 7.
    Fox AJ, Bedi A, Rodeo SA (2012) The basic science of human knee menisci: structure, composition, and function. Sports Health 4(4):340–351CrossRefGoogle Scholar
  8. 8.
    Ganderup T, Jensen C, Holsgaard-Larsen A, Thorlund JB (2017) Recovery of lower extremity muscle strength and functional performance in middle-aged patients undergoing arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 25(2):347–354CrossRefGoogle Scholar
  9. 9.
    Ha AY, Shalvoy RM, Voisinet A, Racine J, Aaron RK (2016) Controversial role of arthroscopic meniscectomy of the knee: a review. World J Orthop 7(5):287–292CrossRefGoogle Scholar
  10. 10.
    Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B et al (2000) Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med 342(14):1016–1022CrossRefGoogle Scholar
  11. 11.
    Herrlin SV, Wange PO, Lapidus G, Hallander M, Werner S et al (2013) Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 21(2):358–364CrossRefGoogle Scholar
  12. 12.
    Hughston JC (1975) A simple meniscectomy. J Sports Med 3(4):179–187CrossRefGoogle Scholar
  13. 13.
    Katz JN, Brophy RH, Chaisson CE, Chaves L, Cole BJ et al (2013) Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 368(18):1675–1684CrossRefGoogle Scholar
  14. 14.
    Kim S, Bosque J, Meehan JP, Jamali A, Marder R, (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Jt Surg Am 93(11):994–1000CrossRefGoogle Scholar
  15. 15.
    Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR et al (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359(11):1097–1107CrossRefGoogle Scholar
  16. 16.
    Lee BS, Bin SI, Kim JM, Park MH, Lee SM et al (2019) Partial meniscectomy for degenerative medial meniscal root tears shows favorable outcomes in well-aligned, nonarthritic knees. Am J Sports Med.  https://doi.org/10.1177/0363546518819225 Google Scholar
  17. 17.
    Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50(10):3145–3152CrossRefGoogle Scholar
  18. 18.
    Lohmander LS, Roos H (1994) Knee ligament injury, surgery and osteoarthrosis. Truth or consequences? Acta Orthop Scand 65(6):605–609CrossRefGoogle Scholar
  19. 19.
    Maher SA, Rodeo SA, Warren RF (2017) The meniscus. J Am Acad Orthop Surg 25(1):e18–e19CrossRefGoogle Scholar
  20. 20.
    Marsh JD, Birmingham TB, Giffin JR, Isaranuwatchai W, Hoch JS et al (2016) Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee. BMJ Open 6(1):e009949CrossRefGoogle Scholar
  21. 21.
    Matsusue Y, Thomson NL (1996) Arthroscopic partial medial meniscectomy in patients over 40 years old: a 5- to 11-year follow-up study. Arthroscopy 12(1):39–44CrossRefGoogle Scholar
  22. 22.
    McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Jt Surg Br 88(12):1549–1556CrossRefGoogle Scholar
  23. 23.
    Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA et al (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 347(2):81–88CrossRefGoogle Scholar
  24. 24.
    Parker BR, Hurwitz S, Spang J, Creighton R, Kamath G (2016) Surgical trends in the treatment of meniscal tears: analysis of data from the American Board of Orthopaedic Surgery Certification Examination Database. Am J Sports Med 44(7):1717–1723CrossRefGoogle Scholar
  25. 25.
    Petty CA, Lubowitz JH (2011) Does arthroscopic partial meniscectomy result in knee osteoarthritis? A systematic review with a minimum of 8 years’ follow-up. Arthroscopy 27(3):419–424CrossRefGoogle Scholar
  26. 26.
    Potts A, Harrast JJ, Harner CD, Miniaci A Jones MH (2012) Practice patterns for arthroscopy of osteoarthritis of the knee in the United States. Am J Sports Med 40(6): 1247–1251CrossRefGoogle Scholar
  27. 27.
    Rongen JJ, Rovers MM, van Tienen TG, Buma P, Hannink G, (2017) Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative. Osteoarthr Cartil 25(1):23–29CrossRefGoogle Scholar
  28. 28.
    Roos EM (2005) Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol 17(2):195–200CrossRefGoogle Scholar
  29. 29.
    Roos H, Adalberth T, Dahlberg L, Lohmander LS (1995) Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthr Cartil 3(4):261–267CrossRefGoogle Scholar
  30. 30.
    Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K et al (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41(4):687–693CrossRefGoogle Scholar
  31. 31.
    Salata MJ, Gibbs AE, Sekiya JK (2010) A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med 38(9):1907–1916CrossRefGoogle Scholar
  32. 32.
    Sihvonen R, Paavola M, Malmivaara A, Itala A, Joukainen A et al (2013) Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 369(26):2515–2524CrossRefGoogle Scholar
  33. 33.
    Sniekers YH, Weinans H, van Osch GJ, van Leeuwen JP (2010) Oestrogen is important for maintenance of cartilage and subchondral bone in a murine model of knee osteoarthritis. Arthritis Res Ther 12(5):R182CrossRefGoogle Scholar
  34. 34.
    van de Graaf VA, Wolterbeek N, Mutsaerts EL, Scholtes VA, Saris DB et al (2016) Arthroscopic partial meniscectomy or conservative treatment for nonobstructive meniscal tears: a systematic review and meta-analysis of randomized controlled trials. Arthroscopy 32(9):1855.e4–1865.e4Google Scholar
  35. 35.
    Walker PS, Erkman MJ (1975) The role of the menisci in force transmission across the knee. Clin Orthop Relat Res 109:184–192CrossRefGoogle Scholar
  36. 36.
    Yim JH, Seon JK, Song EK, Choi JI, Kim MC et al (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41(7):1565–1570CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of OrthopaedicsThe University of Kansas Medical CenterKansas CityUSA

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