Anterior cruciate ligament reconstruction is not for all—a need for improved patient selection

In an interesting article by Eggerding et al ,1 the authors conducted a cost-utility analysis for two treatment strategies for patients who sustain an anterior cruciate ligament (ACL) tear; early ACL reconstruction versus rehabilitation plus an optional reconstruction in case of persistent instability. The randomised controlled study included patients with ACL tear aged 18–65 years. The authors found that it takes 48460 € from a healthcare perspective and 78179 € from a societal perspective to gain a quality-adjusted life year (QALY) when performing early surgery compared with rehabilitation plus optional reconstruction. How much are we willing to pay to gain a QALY, and what is the best way to use limited resources? Most previous studies have focused on patient function and satisfaction, and with increasing economic burden in most countries, studies such as this one evaluating cost-utility are necessary. Anterior cruciate ligament reconstruction (ACL-R) is one of the most commonly performed procedures in orthopaedic sports medicine. Increased sports participation and training load in the youth, and the desire to stay active into old age are among the factors that have contributed to the increased injury burden. The number of ACL-R procedures has increased in the last two decades in most countries in the western world. It is also possible that advances in surgical techniques have led to an increased number of ACL-R. The …