Dataset Information

Circumferential Suture Repair of Isolated Horizontal Meniscal Tears Augmented With Fibrin Clot.

ABSTRACT: Traditionally, horizontal cleavage meniscus tears have been associated with osteoarthritis, indicative of the degenerative process. Recent treatment measures have focused on maintaining as much meniscal tissue as possible, despite the routine extension of these tears into the central white-white zones. In the absence of tunnel drilling for cruciate ligament reconstructions, the use of an exogenous fibrin clot is a useful adjunct to increase the local growth factors at the tear repair to aid in healing. This surgical technique is to describe the use of an all-arthroscopic tied circumferential suture repair of horizontal meniscal tears augmented with exogenous fibrin clot to treat all locations of horizontal meniscal tears.

SUBMITTER: Laidlaw MS

PROVIDER: S-EPMC5709922 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Circumferential Suture Repair of Isolated Horizontal Meniscal Tears Augmented With Fibrin Clot.

Laidlaw Michael S MS Gwathmey F Winston FW

Arthroscopy techniques 20171012 5

Traditionally, horizontal cleavage meniscus tears have been associated with osteoarthritis, indicative of the degenerative process. Recent treatment measures have focused on maintaining as much meniscal tissue as possible, despite the routine extension of these tears into the central white-white zones. In the absence of tunnel drilling for cruciate ligament reconstructions, the use of an exogenous fibrin clot is a useful adjunct to increase the local growth factors at the tear repair to aid in h ...[more]

PMID: 29354475

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Project description:PurposeTo determine the cost-effectiveness of meniscal repair (MR) using an all-suture-based technique when compared to partial meniscectomy (PM) for horizontal cleavage tears (HCTs) from a payor's perspective in the United States.MethodsA state-transition model and cost-utility analysis were developed from a US payor's perspective to project treatment costs and quality-adjusted life-years (QALYs) in a cohort of 35-year-old patients without osteoarthritis at baseline and presenting with either a lateral or medial HCT. Two outpatient costing perspectives were used, namely ambulatory surgical centers (ASCs) and hospitals. The state-transition model had 7 health states with transition probabilities, costs, and utilities obtained from the existing literature. Cost-effectiveness was assessed using a willingness-to-pay threshold of $100,000/QALY, and sensitivity analysis considered the effects of parameter uncertainty on model results. MR failure rates were focused on an all-suture-based technique; however, in a separate scenario, this study considered effectiveness data from various MR techniques and devices.ResultsMR dominated PM over a lifetime horizon, increasing QALYs by 0.43 per patient and decreasing the cost by $12,227 per patient within a hospital setting (and by $12,570 within an ASC). MR with an all-suture-based technique continued to be the dominant treatment when age at primary treatment was varied between 30 and 60 years. Sensitivity analysis showed that MR was not cost-effective in year 1, was cost-effective from year 2, and was cost-saving from year 6 onward from both ASC and hospital perspectives. Probabilistic sensitivity analysis found that MR was cost-effective over a lifetime horizon in 99% of 10,000 iterations on base-case analysis.ConclusionsUsing a lifetime horizon, this study found that from a payor's perspective, MR is a cost-saving intervention when compared with PM in patients with an HCT.Level of evidenceLevel III, economic analysis.

Dataset Information

Circumferential Suture Repair of Isolated Horizontal Meniscal Tears Augmented With Fibrin Clot.

Publications

Circumferential Suture Repair of Isolated Horizontal Meniscal Tears Augmented With Fibrin Clot.

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