Abstract
Purpose
To determine the cost‐effectiveness of knotted (KT) versus knotless (KL) methods for rotator cuff surgical repair and to assess differences in patients’ outcomes.
Methods
We retrospectively identified all patients who underwent arthroscopic rotator cuff repair at 1 institution by 1 surgeon over 2 6‐month periods of time (KT technique from August 1, 2013, through January 31, 2014; and KL technique from December 1, 2014, through May 31, 2015) to calculate the direct and indirect costs associated with arthroscopic KT or KL suture bridge rotator cuff repair. Patient demographics, number of anchors used, tendons repaired, procedure time, operative time, and clinical results were also evaluated. We used univariate generalized linear models with a Gaussian distribution for assessment scores and total and implant cost data.
Results
We identified 87 patients for inclusion during the 2 time frames (35 KT, 54 KL). After excluding patients for tear size 2
(n = 42), ≤ 3 anchors (n = 5), revision surgery (n = 1), and those in whom additional procedures were performed (n = 2), 37 eligible subjects remained (n
KT
= 15, n
KL
= 22). Median implant costs were statistically significantly higher in the KL group than in the KT group (M
KL
= $2,127, M
KT
= $1,520, β = 413.7, 95% CI: 242.8, 584.6,
P
P
= .02). Procedure time was cut in half with KL repair (estimated 43.5 minutes) versus KT repair (80 minutes) (β = 0.5, 95% CI: 0.4, 0.6,
P
P
KL
= $3788.40, M
KT
= $4262.90, β = –492.1, 95% CI: –840.0, –144.1,
P
P
> 0.05 for all).
Conclusions
Despite using more anchors and incurring higher implant costs, the KL technique for rotator cuff repair required less surgical procedure time and cost less overall than the KT technique and resulted in equivalent clinical results.
Level of Evidence
Level IV Economic and Decision Analyses.