2017 ISAKOS Biennial Congress ePoster #1134

 

A Comparison of Four Alternative National Universal Anterior Cruciate Ligament Injury Prevention Program Implementation Strategies to Reduce Secondary Future Medical Costs.

Christopher J. Vertullo, MBBS, PhD, FRACS(Orth), Gold Coast, QLD AUSTRALIA
Dion Lewis, MBBS, Gold Coast, QLD AUSTRALIA
Brent Kirkbride, BAppSC, MAppsc, Sydney, NSW AUSTRALIA
Louisa Gordan, PhD, Brisbane, QLD AUSTRALIA
Tracy Comans, PhD, Gold Coast, QLD AUSTRALIA

Knee Research Australia & Menzies Health Institute, Gold Coast, QLD, AUSTRALIA

FDA Status Not Applicable

Summary

An ACL Injury Prevention Program is most effective when implemented for 12- 25 year olds who are high risk sport participants.

Abstract

Background/Aim
Anterior Cruciate ligament (ACL) injury is a common and devastating sporting injury. With or without ACL reconstruction, the risk of knee osteoarthritis (OA) and permanent disability later in life is markedly increased. While neuromuscular training programs can prevent 50–80% of ACL injuries, no national implementation strategies have been examined. The aim of this study was to compare the ability of four alternative national universal ACL injury prevention program implementation strategies to reduce future medical costs secondary to ACL injury.

Methods

A Markov economic decision model was constructed to estimate the value in lifetime future medical costs prevented by implementing a national ACL prevention program amongst four hypothetical cohorts: high risk sport participants (HR) aged 12-25 years; HR 18 -25 years; HR 12 -17 years; all youths (ALL) 12-17 years.

Results

Of the 4 programs examined, the HR 12-25 program provided the greatest value, averting $693 of direct health care costs per person per lifetime or $221,870,880 in total. Without training, 9.4% of this cohort will rupture their ACL and 16.8% will develop knee OA. Training prevents 3764 lifetime ACL ruptures per 100,000 individuals, a 40% reduction in ACL injuries. 842 lifetime cases of OA per 100,000 individuals, and 584 TKRs per 100,000 are subsequently averted. Numbers needed to treat ranged from 27 for the HR12-25 to 190 for the ALL12-17.

Conclusion

A program aimed at 12 - 25-year-olds who were participants in high-risk sports was the most effective implementation strategy. Estimation of the break-even cost of health expenditure savings will enable optimal future program design, implementation, and expenditure.