Return to play is a big concern for athletes after anterior cruciate ligament (ACL) reconstruction. Standard post-operative rehabilitation has shown good results; however, a new study suggests that an enhanced return to play program can be cost-effective.
ACL: Enhanced Return to Play Program Proven Cost-Effective
1 min read Premium comments
#aclreconstructionSecondary#enhancedreturntoplaystrategy
In “Safer and Cheaper: An Enhanced Milestone-Based Return to Play Program After Anterior Cruciate Ligament Reconstruction in Young Athletes Is Cost-Effective Compared With Standard Time-Based Return to Play Criteria,” published on March 17, 2020 in The American Journal of Sports Medicine, researchers used a decision-analysis model to compare standard rehabilitation with an enhanced return to play strategy, one that includes additional neuromuscular retraining, advanced testing, and follow-up physician visits.
Cost-effectiveness was determined from a payer perspective and included costs of surgical procedures and rehabilitation protocols, risks of graft rupture and contralateral ACL injury, and risk reductions.
At base analysis, the enhanced return to play strategy for rehabilitation costs about $969 more than standards protocol, however, it also provided a 25% risk reduction for graft rupture.
The researchers determined that the enhanced return to play (eRTP) program was cost-effective compared to traditional rehabilitation as long as its additional cost was less than $2,092 or it decreased the incidence of contralateral ACL rupture by more than 13.8%.
They wrote, “The eRTP strategy in this study adds additional neuromuscular retraining and additional physician follow-up—as well as advanced testing goals upon which RTP is contingent—to traditional physical therapy. Our data suggest that these additions are cost-effective, even assuming only modest associated decreases in ACL graft failure.
“This study also determined that the only variable that had the potential to change the cost-effectiveness conclusion based on predetermined ranges was the additional cost of rehabilitation based on 1-way sensitivity analysis.”
The sensitivity analysis used in the study can be used to determine the cost-effectiveness of any return to play program regardless of the specific elements of the program.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.