Trends in treatment of anterior cruciate ligament injuries of the knee in the public and private healthcare systems of Brazil

Authors

  • Diego Costa Astur Universidade Federal de São Paulo
  • Rodrigo Ferreira Batista Universidade Federal de São Paulo
  • Arliani Gustavo Universidade Federal de São Paulo
  • Moises Cohen Universidade Federal de São Paulo

Keywords:

Anterior cruciate ligament, Surgical procedures, operative, Anterior cruciate ligament reconstruction, Delivery of health care, Healthcare disparities

Abstract

CONTEXT AND OBJECTIVE: Orthopedic surgery implies high costs for both public and private healthcare. The aim of this study was to better understand the differences between the public and private sectors regarding treatment of a damaged anterior cruciate ligament, which is a common knee injury. DESIGN AND SETTING: Descriptive cross-sectional study conducted during the Brazilian Orthopedics Congress in Brasília. METHODS: We applied questionnaires during the 2010 Brazilian Orthopedics Congress, with participation by 241 knee surgeons from 24 Brazilian states. This was followed by statistical analysis on the data that were obtained. RESULTS: The orthopedic surgeons who were evaluated used different approaches and treatment options in different Brazilian states, comparing between the public and private systems. CONCLUSION: Both in the public and in the private systems in Brazil, because of non-medical issues surrounding the treatment, the best medical decision is not always made. This may be harmful both to patients and to physicians.

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Author Biographies

Diego Costa Astur, Universidade Federal de São Paulo

MD. Orthopedist, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.

Rodrigo Ferreira Batista, Universidade Federal de São Paulo

MD. Resident, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.

Arliani Gustavo, Universidade Federal de São Paulo

MD. Orthopedist, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.

Moises Cohen, Universidade Federal de São Paulo

MD, PhD. Full Professor and Head, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.

References

Duthon VB, Barea C, Abrassart S, et al. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):204-13.

Matsumoto H, Suda Y, Otani T, et al. Roles of the anterior cruciate ligament and the medial collateral ligament in preventing valgus instability. J Orthop Sci. 2001;6(1):28-32.

Sakane M, Fox RJ, Woo SL, et al. In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res. 1997;15(2):285-93.

Cohen M, Astur Dda C, Kaleka CC, et al. Introducing 3-dimensional stereoscopic imaging to the study of musculoskeletal anatomy. Arthroscopy. 2011;27(4):593-6.

Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35(10):1756-69.

Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med. 2012;22(4):349-55.

Bottoni CR, Liddell TR, Trainor TJ, Freccero DM, Lindell KK. Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: a prospective, randomized clinical trial of early versus delayed reconstructions. Am J Sports Med. 2008;36(4):656-62.

Farshad M, Gerber C, Meyer DC, et al. Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis. BMC Health Serv Res. 2011;11:317.

Lubowitz JH, Appleby D. Cost-effectiveness analysis of the most common orthopaedic surgery procedures: knee arthroscopy and knee anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(10):1317-22.

Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport. 2009;12(6):622-7.

Cháidez-Reyes JC, Almazán-Díaz A, Espinosa-Morales R, et al. Análisis de costo e impacto económico de la reconstrucción de ligamento cruzado anterior (LCA) [Cost analysis and economic impact of anterior cruciate ligament reconstruction]. Acta Ortop Mex. 2009;23(6):331-5.

Cimino F, Volk BS, Setter D. Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician. 2010;82(8):917-22.

Balsini N. Cirurgia ambulatorial no Centro de Ortopedia e Fraturas de Joinville: experiência pessoal de 3 anos na reconstruçäo do ligamento cruzado anterior [Outpatient surgery in “Centro de Ortopedia e Fraturas de Joinville: a 3 years personal experience in the anterior cruciate ligament reconstruction]. Rev Bras Ortop. 1995;30(5): 274-8.

Farnworth LR, Lemay DE, Wooldridge T, et al. A comparison of operative times in arthroscopic ACL reconstruction between orthopaedic faculty and residents: the financial impact of orthopaedic surgical training in the operating room. Iowa Orthop J. 2001;21:31-5.

Linko E, Harilainen A, Malmivaara A, Seitsalo S. Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults. Cochrane Database Syst Rev. 2005;(2):CD001356.

Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363(4):331-42.

Healy WL, Iorio R. Implant selection and cost for total joint arthroplasty: conflict between surgeons and hospitals. Clin Orthop Relat Res. 2007;457:57-63.

Maffulli N, Longo UG, Denaro V. Anterior cruciate ligament tear. N Engl J Med. 2009;360(14):1463; author reply 1463.

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Published

2013-07-07

How to Cite

1.
Astur DC, Batista RF, Gustavo A, Cohen M. Trends in treatment of anterior cruciate ligament injuries of the knee in the public and private healthcare systems of Brazil. Sao Paulo Med J [Internet]. 2013 Jul. 7 [cited 2025 Mar. 14];131(4):257-63. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/1322

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Original Article