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Anterior cruciate ligament reconstruction is not for all—a need for improved patient selection
  1. Gilbert Moatshe1,2,
  2. Christopher Y Kweon3,
  3. Albert O Gee3,
  4. Lars Engebretsen2,4
  1. 1Orthopaedic Division, Oslo University Hospital, Oslo, Norway
  2. 2Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
  3. 3University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington, USA
  4. 4Department of Ortho Surg, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Gilbert Moatshe, Orthopaedic Division, Oslo University Hospital, 0450 Oslo, Norway; gilbertmoatshe{at}gmail.com

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In an interesting article by Eggerding et al,1 the authors conducted a cost-utility analysis for two treatment strategies for patients who sustain an anterior cruciate ligament (ACL) tear; early ACL reconstruction versus rehabilitation plus an optional reconstruction in case of persistent instability. The randomised controlled study included patients with ACL tear aged 18–65 years. The authors found that it takes 48460 € from a healthcare perspective and 78179 € from a societal perspective to gain a quality-adjusted life year (QALY) when performing early surgery compared with rehabilitation plus optional reconstruction. How much are we willing to pay to gain a QALY, and what is the best way to use limited resources? Most previous studies have focused on patient function and satisfaction, and with increasing economic burden in most countries, studies such as this one evaluating cost-utility are necessary.

The clinical problem

Anterior cruciate ligament reconstruction (ACL-R) is one of the most commonly performed procedures in orthopaedic sports medicine. Increased sports participation and training load in the youth, and the desire to stay active into old age are among the factors that have contributed to the increased injury burden. The number of ACL-R procedures has increased in the last two decades in most countries in the western world. It is also possible that advances in surgical techniques have led to an increased number of ACL-R. The …

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Footnotes

  • Twitter @GilbertMoatshe, @larsengebretsen

  • Contributors All authors (GM, CK, AG and LE) have contributed substantially to this work and meet the ICMJE criteria. They have all made substantial contributions to the conception of the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GM: editorial board—Journal of Arthroscopy. Committee Member—ISAKOSLE: Acta Orthopaedica: Editorial or governing board, American Orthopaedic Society for Sports Medicine: Board or committee member. Arthrex: IP royalties; paid consultant; research support. Biomet: research support. BJSM: publishing royalties, financial or material support. ESSKA: board or committee member. iBalance: stock or stock options. International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member. Journal of Bone and Joint Surgery—American: editorial or governing board. Knee: editorial or governing board. Knee Surgery, sports traumatology, arthroscopy: editorial or governing board. Smith and Nephew: research support.

  • Provenance and peer review Commissioned; externally peer reviewed.

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