How expensive is the decision to suture a meniscal tear? Surgical and monetary concerns in a workers’ compensation population

Abstract

The cost of meniscal sutures and the rate of failure are important concerns in a worker's compensation population. Hypothesis We prospectively analysed our cohort of workers’ compensation patients operated to a meniscal tear in a two years’ period (2013 and 2014) to test two hypothesis: patients submitted to a meniscus suture stay out of work for a longer period of time–monetary compensation is smaller in patients with the sutured meniscus. Material and methods We prospectively analysed a sample of 51 consecutive patients, under 45 years, submitted to either a meniscal suture or a partial meniscectomy (minimum follow-up of 12 months). The exclusion criteria where unstable knees, relevant cartilage lesion (outerbridge grade > = III) and any concomitant surgical procedures (like ligament reconstruction). The patients were analysed using this criteria: cost of surgery (in euros) –sick leave period, permanent disability (measured in percentage) which will lead to monetary compensation, pre and postoperative Lysholm and IKDC scores. Results There were 51 patients consecutively operated due to a meniscal tear who met the inclusion criteria. The patients were divided in–Group A–31 patients submitted to partial meniscectomy, Group B–20 patients submitted to meniscal suture The follow-up was similar between groups–group A (average 21, 8 months; min 15, max 28) group B (average 20,3 months; min 12, max 47). In Group A (meniscectomy) the direct cost of the surgery was 1373,8€ (min 1241,52; max 1584,2). Clinical preoperative scores–Lysholm–average 14,9; min 1; max 57.–IKDC–average 20,8; min 5,7; max 47,1. Final postoperative scores - Lysholm- average 63,2; min 16; max 92.–IKDC–average 61,7; min 12,6; max 97,7. Overall 90,3% were satisfied with the treatment result. Permanent disability–8,94% (SD37) The sick leave period was 152,13 (average, with 72,7SD) In Group B, (meniscal suture) the direct cost of the surgery was 1979,8,8€ (min 2462,4; max 4080). Clinical preoperative scores–Lysholm–average 15,7; min 0; max 30.–IKDC–average 21,1; min 8; max 65,5. Final postoperative scores–Lysholm average 88,7; min 70; max 100.–IKDC (at discharge) –average 86; min 34,5; max 100. All patients were satisfied with the treatment result. Permanent disability–1,65% (SD 1,98) The sick leave period was 228,75 (average, with 327 SD). Conclusion The cost of surgery is significantly higher in the suture group ( P P