Sometimes we start to believe our own stories, the ones we use to explain things to patients.
Some of these include-
“The ACL can’t heal.”
“If you want to play cutting sports again, you will need an ACL reconstruction.”
“If you want to protect your cartilage and avoid osteoarthritis, you will need an ACL recon.”
While these beliefs are being challenged, surgical intervention for ACL injury continues to rise. The injury, the operation, and the knee surgeon are all quite…well…glamorous!
Over the last 2 decades, rates of ACL reconstruction have increased 12-fold in England, with some regions performing more than twice the national average. Whilst impressive, this rate is still well below their southern friends.
Rate of ACL reconstruction per 100 000 population-
- Australia 77
- New Zealand 52
- Sweden 32
- England 24
Australia has the highest rate of ACL reconstruction in the OECD!
It would be nice if this was explained by increased exposure though participation (sporty nation that we like to think we are), but the actual number of ACL injuries in these countries remains unknown (excepting perhaps Sweden, who has a longstanding ACL injury registry). Payment structures and access to surgical opportunities in these differing healthcare systems play a large part in this variance.
In Australia, the average hospital and surgical costs of an ACL reconstruction is between $5,076 and $13,950, without considering rehabilitation, societal costs of lost work hours or the cost of downstream osteoarthritis. A recent collaboration between Medibank Private and the Royal Australasian College of Surgeons reported a wide degree of cost variance for ACL reconstructions depending largely on where you live – not the surgical skill or complexity and certainly not the outcomes.
Average out-of-pocket expenses for ACL reconstruction (AUS)
- NSW $2,248
- Vic $1,671
- SA $415
- Range $0 – $2,907
The NZ ACL Registry has been collecting surgical and outcome data since 2015 and will begin collecting outcome data from non-operative management.
Australia also needs a comprehensive ACL registry that includes outcomes of all treatment options as well.
Fortunately, there is growing interest in injury surveillance and real world, functional outcomes of both non-operative and operative management of ACL injuries.
Watch this space.