Regarding “What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients”

We read with great interest the paper “What Are Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in United States? A Cost-Minimization Analysis 14,713 Patients” by Bokshan et al.1Bokshan S.L. Mehta S. DeFroda S.F. Owens B.D. What are primary cost drivers anterior cruciate ligament reconstruction cost-minimization analysis patients.Arthroscopy. 2019; 35: 1576-1581Abstract Full Text PDF PubMed Scopus (16) Google Scholar (ACLR) is a common procedure worldwide, and treatment concomitant lesions both medial lateral menisci gaining popularity. Specifically ramp lesions, which have been reported up to 40% patients undergoing ACLR, shown play dramatic role postoperative stability loads on reconstructed ACL. Therefore, their seems be necessary setting ACL surgery. Bokhsan al. perfectly social costs ACLR its cost-effectiveness. The average for increasing States currently at $24,707. Several factors associated this increase, including patient-specific variables as greater patient age, male sex, Hispanic ethnicity, number chronic medical conditions, Medicare insurance, annual income surgical time spent operating room use general anesthesia. In effort reduce total ensure best treatment, all these aspects should taken into account. Europe, procedures even more relevant daily practice. Italy, right being assisted public health system due universal coverage population financed through tax funding. Italian National Health Service reimburses hospitals subsidized private activity according diagnosis-related group (DRG). This based patients’ pathologies interventions physicians perform accounts hospitalization, implantable materials, physicians. reimbursement 1888€ (code 8145, DRG503) does not vary patient’s comorbidities or whether meniscus reinserted. However, reinsertment an additional implies variation final costs. DRG 1888€, covers 1 night hospitalization (as decided system) (300€), implanted such femoral cortical button (371€), interference tibial screw (433€) (data from Mitek Italy), disposable devices shaver (240€) radiofrequency (290€) occupation (300€ 60 minutes), various other (100€, includes medicines, irrigation bags, sutures, drapes). case that meniscal sutures performed, include 1/2 hour (150€) suture (960€ 2 arrows) Italy). means isolated has fixed 2.034€ (surgical team excluded) while covered 1676.61€. Recent studies two-thirds injuries injury, one-half involved lesion root lesion.2Magosch A, Mouton C, Nührenbörger Seil R. Medial posterior present than third revision reconstructions [published online November 9, 2020]. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06352-3.Google These biomechanical impact knee function therefore reinserted/repaired.3DePhillipo N.N. Moatshe G. Brady A. al.Effect meniscocapsular meniscotibial ACL-deficient ACL-reconstructed knees: study.Am J Med. 2018; 46: 2422-2431Crossref (46) when performed procedure, increase 1150€ expected; brings raise 3184€, but stays 1888€. situation difficult. Major can hardly manage surgery mixing high-volume practice, whereas several smaller stopped practicing sports traumatology operations completely, they result nonprofitable Arthroscopic shoulder (cuff repair instability) shows similar limitations anchors strongly reduced. At moment, results financial loss care providers reinsertion somehow discouraged. For reason, surgeons often prefer resection instead also young athletic because it profitable option, quicker easier perform, shorter recovery period, making less expensive rehabilitation. huge problem since recent epidemiologic, biomechanical, clinical clearly importance repair/reinsertion possible preserve cartilage integrity, protect ACL, decrease reoperation rate further meniscectomy.4Sonnery-Cottet B. Editorial Commentary: Ramp lesion: eye sees only what mind prepared comprehend.Arthroscopy. 2020; 36: 2934-2937Abstract (2) part orthopaedic practice States, performing particularly becoming convenient setting, majority hospitals, where ensured insurance companies (around 4000-5000€). trend major inconveniences. First, experienced older younger having Second, policy reduction negatively influences surgeons’ decision-making, favoring options over proven detrimental sporty patients. service revise DRG-based penalizes sport traumatology, indeed important preventing late joints degeneration.