Decreasing Trends in Arthroscopic Treatment of Knee Osteoarthritis after Publication of the 2013 Academy of Orthopaedic Surgeons Clinical Practice Guidelines

Abstract

Introduction:The purpose of this study was to analyze trends in arthroscopic utilization among patients with an isolated diagnosis of knee osteoarthritis (OA) after publication of the 2013 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG) regarding nonarthroplasty management of knee OA. The 2013 AAOS CPG recommended strongly against the use of arthroscopy for the treatment of knee OA. Our hypothesis was that rates of arthroscopic utilization would decrease after publication of the CPG.Methods:Analysis was conducted using the International Business Machines (IBM) MarketScan Commercial and Medicare Supplemental Databases from 2012 to 2019, which contain healthcare data for more than 43.6 million individuals. This study included patients aged 21 years or older who underwent knee arthroscopy for the isolated diagnosis of knee OA without concomitant pathology.Results:The overall rate of arthroscopic intervention was 59.15 per 1000 patients in 2012 and decreased by 14.91 points to 44.24 per 1000 patients in 2019. This equates to an average decrease of 4.0% year over year from 2012 to 2019, with an overall decrease of 25.2%. The 40-49, 50-59, and 60-69 age groups demonstrated a decrease of 41.5%, 37.2%, and 35.9%, respectively, from 2012 to 2019. Over the same period, there was increased utilization of physical therapy and corticosteroid injections and decrease in viscosupplementation injections.Discussion:This analysis demonstrates a change in practice trends after publication of the 2013 AAOS CPG. Both overall and age cohort-specific arthroscopic utilization rates consistently decreased year over year for all cohorts in accordance with the publication of the 2013 AAOS CPG.