A Cost-Effectiveness Analysis of Isolated Meniscal Repair Versus Partial Meniscectomy for Red-Red Zone, Vertical Meniscal Tears in the Young Adult


      To evaluate the cost-effectiveness of treating isolated red-red zone, vertical meniscal tears with either isolated meniscal repair (IMR) or partial meniscectomy (PM) in the young adult using conservative modeling.


      A decision-analytic Markov disease progression model with a 40-year horizon was created simulating outcomes after IMR or PM for an isolated meniscal tear. Event probabilities, costs, and utilities were used for the index procedures, and the development of osteoarthritis (OA) and subsequent need for knee arthroplasty were calculated or selected from the published literature. Differences in cost, difference in quality-adjusted life years (QALYs), and the incremental cost effect ratio were calculated to determine which index procedure is most cost effective.


      Total direct costs from PM were modeled at $38,648, and the total direct costs of IMR were $23,948, resulting in a projected cost savings of $14,700 with IMR. There was a modeled gain in QALYs of 17 for PM and 21 for IMR, resulting in an increase in 4 QALYs for the IMR treatment group. This results in an incremental cost effect ratio of $3,935 per QALY, favoring IMR as the dominant procedure.


      Meniscal repair for isolated red-red zone, vertical meniscal tears was predicted to have lower direct costs and improve QALYs compared with partial meniscectomy over 40-year modeling, indicating isolated meniscal repair to be the cost-effective procedure in the treatment of an isolated meniscal tear in the young adult population.

      Level of Evidence

      Level 3: economic and decision analysis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Garrett Jr., W.E.
        • Swiontkowski M.F.
        • Weinstein J.N.
        • et al.
        American Board of Orthopaedic Surgery practice of the orthopaedic surgeon: Part-II, certification examination case mix.
        J Bone Joint Surg Am. 2006; 88: 660-667
        • McClure K.E.
        • Morrison W.B.
        5th Ed. Internal Derangements: Menisci and Cartilage. Vol. 1. Churchill Livingstone, London2012
        • Lee S.J.
        • Aadalen K.J.
        • Malaviya P.
        • et al.
        Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee.
        Am J Sports Med. 2006; 34: 1334-1344
        • Fairbank T.J.
        Knee joint changes after meniscectomy.
        J Bone Joint Surg Br. 1948; 30: 664-670
        • Haas A.L.
        • Schepsis A.A.
        • Hornstein J.
        • Edgar C.M.
        Meniscal repair using the FasT-Fix all-inside meniscal repair device.
        Arthroscopy. 2005; 21: 167-175
        • Roos H.
        • Lauren M.
        • Adalberth T.
        • Roos E.M.
        • Jonsson K.
        • Lohmander L.S.
        Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls.
        Arthritis Rheumatism. 1998; 41: 687-693
        • McCarty E.C.
        • Marx R.G.
        • DeHaven K.E.
        Meniscus repair: considerations in treatment and update of clinical results.
        Clin Orthop Rel Res. 2002; : 122-134
        • Laible C.
        • Stein D.A.
        • Kiridly D.N.
        Meniscal repair.
        J Am Acad Orthop Surg. 2013; 21: 204-213
        • Abrams G.D.
        • Frank R.M.
        • Gupta A.K.
        • Harris J.D.
        • McCormick F.M.
        • Cole B.J.
        Trends in meniscus repair and meniscectomy in the United States, 2005-2011.
        Am J Sports Med. 2013; 41: 2333-2339
        • Arnoczky S.P.
        • Warren R.F.
        Microvasculature of the human meniscus.
        Am J Sports Med. 1982; 10: 90-95
        • Nepple J.J.
        • Dunn W.R.
        • Wright R.W.
        Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis.
        J Bone Joint Surg Am. 2012; 94: 2222-2227
        • Stein T.
        • Mehling A.P.
        • Welsch F.
        • von Eisenhart-Rothe R.
        • Jager A.
        Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears.
        Am J Sports Med. 2010; 38: 1542-1548
        • Nwachukwu B.U.
        • Schairer W.W.
        • Bernstein J.L.
        • Dodwell E.R.
        • Marx R.G.
        • Allen A.A.
        Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review.
        Am J Sports Med. 2014; 43: 1530-1537
        • Lubowitz J.H.
        • Appleby D.
        Cost-effectiveness analysis of the most common orthopaedic surgery procedures: knee arthroscopy and knee anterior cruciate ligament reconstruction.
        Arthroscopy. 2011; 27: 1317-1322
        • Feeley B.T.
        • Liu S.
        • Garner A.M.
        • Zhang A.L.
        • Pietzsch J.B.
        The cost-effectiveness of meniscal repair versus partial meniscectomy: a model-based projection for the United States.
        Knee. 2016; 23: 674-680
        • Gottlob C.A.
        • Baker Jr., C.L.
        Anterior cruciate ligament reconstruction: socioeconomic issues and cost effectiveness.
        Am J Orthop (Belle Mead, NJ). 2000; 29: 472-476
        • Gottlob C.A.
        • Baker Jr., C.L.
        • Pellissier J.M.
        • Colvin L.
        Cost effectiveness of anterior cruciate ligament reconstruction in young adults.
        Clin Orthop Rel Res. 1999; 367: 272-282
        • Ihn J.C.
        • Kim S.J.
        • Park I.H.
        In vitro study of contact area and pressure distribution in the human knee after partial and total meniscectomy.
        Int Orthop. 1993; 17: 214-218
        • DiBonaventura M.
        • Gupta S.
        • McDonald M.
        • Sadosky A.
        Evaluating the health and economic impact of osteoarthritis pain in the workforce: results from the National Health and Wellness Survey.
        BMC Musculoskel Disord. 2011; 12: 83
        • Odum S.
        • Troyer J.
        • Kelly M.
        • Dedini R.
        • Bozic K.
        A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty.
        J Bone Joint Surg Am. 2013; 95: 1441-1449
        • Paxton E.S.
        • Stock M.V.
        • Brophy R.H.
        Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes.
        Arthroscopy. 2011; 27: 1275-1288
        • Mather 3rd, R.C.
        • Koenig L.
        • Kocher M.S.
        • et al.
        Societal and economic impact of anterior cruciate ligament tears.
        J Bone Joint Surg Am. 2013; 95: 1751-1759
        • Muraki S.
        • Akune T.
        • Oka H.
        • et al.
        Incidence and risk factors for radiographic knee osteoarthritis and knee pain in Japanese men and women: a longitudinal population-based cohort study.
        Arthritis Rheumatism. 2012; 64: 1447-1456
        • Ginsburg P.B.
        Wide variation in hospital and physician payment rates evidence of provider market power.
        Res Brief. 2010; 16: 1-11
        • Bozic K.J.
        • Stacey B.
        • Berger A.
        • Sadosky A.
        • Oster G.
        Resource utilization and costs before and after total joint arthroplasty.
        BMC Health Serv Res. 2012; 12: 73
        • Grootendorst P.
        • Marshall D.
        • Pericak D.
        • Bellamy N.
        • Feeny D.
        • Torrance G.W.
        A model to estimate health utilities index mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the knee.
        J Rheumatol. 2007; 34: 534-542
        • Losina E.
        • Paltiel A.D.
        • Weinstein A.M.
        • et al.
        Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty.
        Arthritis Care Res (Hoboken, NJ). 2015; 67: 203-215
        • Ruiz D.
        • Koenig L.
        • Dall T.M.
        • et al.
        The direct and indirect costs to society of treatment for end-stage knee osteoarthritis.
        J Bone Joint Surg Am. 2013; 95: 1473-1480
        • Losina E.
        • Walensky R.P.
        • Kessler C.L.
        • et al.
        Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume.
        Arch Intern Med. 2009; 169: 1113
        • Mather 3rd, R.C.
        • Garrett W.E.
        • Cole B.J.
        • et al.
        Cost-effectiveness analysis of the diagnosis of meniscus tears.
        Am J Sports Med. 2015; 43: 128-137
        • Mather 3rd, R.C.
        • Hettrich C.M.
        • Dunn W.R.
        • et al.
        Cost-effectiveness analysis of early reconstruction versus rehabilitation and delayed reconstruction for anterior cruciate ligament tears.
        Am J Sports Med. 2014; 42: 1583-1591
        • Stewart B.A.
        • Momaya A.M.
        • Silverstein M.D.
        • Lintner D.
        The cost-effectiveness of anterior cruciate ligament reconstruction in competitive athletes.
        Am J Sports Med. 2017; 45: 23-33
        • Gupta S.
        • Hawker G.A.
        • Laporte A.
        • Croxford R.
        • Coyte P.C.
        The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition.
        Rheumatology (Oxford, England). 2005; 44: 1531-1537
        • Kurzweil P.R.
        • Lynch N.M.
        • Coleman S.
        • Kearney B.
        Repair of horizontal meniscus tears: a systematic review.
        Arthroscopy. 2014; 30: 1513-1519
        • Moulton S.G.
        • Bhatia S.
        • Civitarese D.M.
        • Frank R.M.
        • Dean C.S.
        • LaPrade R.F.
        Surgical techniques and outcomes of repairing meniscal radial tears: a systematic review.
        Arthroscopy. 2016; 32: 1919-1925

      Linked Article

      • Editorial Commentary: Save the Meniscus? Show Me the Money!
        ArthroscopyVol. 35Issue 12
        • Preview
          The meniscus is known to play a vital role in the knee joint from, shock absorption to increased contact area to joint lubrication. Repairing a torn meniscus costs money, but it can be even more expensive to perform a partial meniscectomy over the long term. Moreover, meniscal repair may result in an improved quality of life for the patient. One must consider both quality of life and costs when addressing repairable meniscal tears in patients. Repairing a vertical meniscus tear in the red-red zone in a young adult is a cost-effective strategy.
        • Full-Text
        • PDF