Cost Mitigation Using Implant-Minimizing Techniques in Multiligamentous Injuries of Knee.

Introduction: The recent advances in surgical techniques have resulted in increasing number of knee preservation surgeries including ligament reconstructions/repairs which adds to the financial burden in healthcare. Important hurdles in doing arthroscopic surgery are high cost and lack of sophisticated options like allografts. To overcome these, we have developed some simple yet effective implant-minimizing techniques (IMTs) which help minimize implants use and allografts for ligament reconstruction around knee.

Methods: IMTs help us in minimizing the cost burden by reducing the amount of implants used in multiligament surgeries of knee. There are 4 IMTs that bypass implants for graft fixation. They include 1. Confluent tunnel technique for combined ACL, LCL reconstruction, combined PCL, MCL reconstruction, and combined ACL, ALL reconstruction; 2. bone bridge technique for the combined ACL reconstruction and meniscal root repair, combined ACL, and ALL reconstruction, and tibial MCL repair; 3. suture bridge technique for MPFL reconstruction; and 4. cinch knot technique for LCL reconstruction. The cost- effectiveness between two techniques were analyzed.

Results: Our methods proved to be cost effective with a percentage difference in cost of more than 60 percentage when compared to standard methods of fixation. Patients showed good-to-excellent functional outcomes, with no major complications.

Conclusion: IMTs helped us minimize cost by 60 percentage when compared to standard techniques. They also helped us minimize graft usage, preserve bone stock and avoid tunnel convergence particularly useful in smaller Indian knees. These techniques can be followed without special instrumentation.