Presentation Abstract

Session: 751-765-Sports Medicine/Arthroscopy VI
Date/Time: Friday, Mar 14, 2014, 2:06 PM - 2:12 PM
Location Room 345
Presentation Number: Paper 756
Title: Prevention Programs for Anterior Cruciate Ligament Injuries: A Cost-Effectiveness Analysis
Classification: +Knee- ACL (Primary, Revision, Complications) (Sports Med/Arthro)
Keywords: Economic / Cost Analysis; ACL Outcomes
Author(s): Eric F. Swart, MD, New York, New York
Lauren H. Redler, MD, New York, New York
Peter D. Fabricant, MD, MPH, New York, New York
Bert Mandelbaum, MD, Santa Monica, California
Christopher S. Ahmad, MD, New York, New York
Claire Wang, MD, PhD, New York, New York
Abstract: INTRODUCTION: Anterior cruciate ligament (ACL) injuries are common among young athletes, and represent a significant source of morbidity and financial expense. Biomechanical studies have led to the development of training programs to improve neuromuscular control and reduce ACL injury rates as well as screening tools to identify athletes at higher risk for ACL injury. The purpose of this study was to evaluate the cost-effectiveness of these training methods and screening strategies in preventing ACL injuries.
METHODS: A decision-analytic model was created to evaluate three strategies for a population of young athletes participating in organized sports: 1) no training or screening, 2) universal neuromuscular training and 3) universal screening, with neuromuscular training for identified high-risk athletes only. Risk of injury, risk reduction from training and sensitivity and specificity of screening were based on published data from clinical trials. Costs of training and screening programs were estimated based on existing literature. Sensitivity analyses were performed on key model parameters to evaluate their effect on base case conclusions.
RESULTS: Universal neuromuscular training of all athletes dominated screening to be the most cost-effective strategy. On average, the implementation of a universal training program would save $275 per player per season, and would reduce the incidence of ACL injury from 0.03 to 0.011 per player per season. Screening was not cost effective within the range of reported sensitivity and specificity values.
DISCUSSION AND CONCLUSION: Given its low cost and ease of implementation, neuromuscular training of all young athletes represents a cost effective strategy for reducing costs and morbidity from ACL injuries. While continued innovations on inexpensive and accurate screening methods to identify high-risk athletes remain of interest, improving existing training protocols and implementing neuromuscular training into routine training for all young athletes is warranted.

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