Kern Kent, Murray Jayson, Chen Antonia, Fillingham Yale, Miller Benjamin, Roberts Karl
From the Corewell Health Orthopedic Surgery, Grand Rapids, MI. U.S. (Dr. Kern); Clinical Quality and Value at American Academy of Orthopaedic Surgeons, Rosemont, IL. U.S. (Mr. Murray); University of Texas Southwestern, Dallas, TX. U.S. (Dr. Chen); Rothman Orthopaedics , Philadelphia, PA. U.S. (Dr. Fillingham); University of Iowa, Iowa City, IA. U.S. (Dr. Miller); and West Michigan Orthopedics, Grand Rapids, MI. U.S. (Dr. Roberts).
J Am Acad Orthop Surg Glob Res Rev. 2025 Aug 19;9(8). doi: 10.5435/JAAOSGlobal-D-25-00203. eCollection 2025 Aug 1.
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.
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.
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.
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.
本研究的目的是分析在2013年美国矫形外科医师学会（AAOS）发布关于膝关节骨关节炎（OA）非关节置换治疗的临床实践指南（CPG）之后，单纯诊断为膝关节OA的患者关节镜使用趋势。2013年AAOS CPG强烈反对使用关节镜治疗膝关节OA。我们的假设是CPG发布后关节镜使用率会下降。
使用国际商业机器公司（IBM）的MarketScan商业和医疗保险补充数据库进行分析，时间跨度为2012年至2019年，该数据库包含超过4360万个人的医疗数据。本研究纳入了年龄在21岁及以上、因单纯诊断为膝关节OA且无合并病变而接受膝关节镜检查的患者。
2012年关节镜干预的总体发生率为每1000例患者59.15例，到2019年下降了14.91个百分点，降至每1000例患者44.24例。这相当于2012年至2019年期间年平均下降4.0%，总体下降25.2%。40 - 49岁、50 - 59岁和60 - 69岁年龄组在2012年至2019年期间分别下降了41.5%、37.2%和35.9%。在同一时期，物理治疗和皮质类固醇注射的使用率增加，而玻璃酸钠注射的使用率下降。
该分析表明，2013年AAOS CPG发布后实践趋势发生了变化。根据2013年AAOS CPG的发布，所有队列的总体和特定年龄组的关节镜使用率均逐年持续下降。
