The Cost of an ACL Injury

If you don't plan on playing semi-competitive sports ever again, I wouldn't recommend surgery. It's all about the planting of the foot and changing direction, which you don't do with straight line activities like running or biking.

Forget about working the first week after surgery. You need to elevate and extend your leg constantly for the first few months, which gets uncomfortable when sitting.

Pre-surgery you need to strengthen the muscles around the knee to speed up recovery, so my physio got me to go to the gym 3X a week for two months, biking hard. Post-surgery you need to use some gym equipment as home rehab doesn't cut it.

Also it takes two years to fully heal. After seven months I could hike and bike, but now I'm sixteen months in and only now have started to play light competitive sports again. However mine is more complex as I have torn miniscus and some residual scar tissue that may be removed in the future. Let me know if you have other questions about the process, it's a long one!

I also had my ACL replaced (hamstring autograft), in SF, about 2.5 years ago after a basketball injury.

I'm pretty sure these prices are starting 'list' prices, whereas the negotiated/'allowed' cost that you and your insurance company actually wind up paying tends to be 1/2 to 1/3 these numbers.

My surgery was also about 3 months after the injury, which isn't optimal. It took me a few weeks to see a doctor, I didn't like the 1st doctor I saw, and by the time I'd settled on a preferred one, I needed 6 weeks of physical therapy to undo some of the post-injury weakening of surrounding muscles. (Since there's also atrophying due to surgical damage and post-surgery immobilization, it's best for recovery for the muscles to be as strong as possible going in. So diagnosis/surgery ASAP after injury, with muscles nearly at their pre-injury best, is preferred... if you suspect your ACL is torn see a doc quickly!)

ACL stands for Anterior Cruciate Ligament. (In case I'm not the only one who didn't know and was surprised to see this was never mentioned in the article or the comments.)

Crazy, but dog lifespan is considerably less. How long does the repair really have to last for?

So, I have a few questions.

> Going in, I had anticipated that doctors would take the lion’s share of the costs. I was surprised when the facilities ended up being the dominant cost; over 40% of the total.

Is that because you're paying for the cost of nurses here, rather than breaking that cost out elsewhere?

> This centimeter-wide cutting machine cost $900 according to the price sheet.

That seems to be a bit much. I'm used to silly prices for tools and equipment in electronics, but still. Perhaps they're charging you for the whole tool, and not just the disposable blade? (Which would seem to be a bit cheeky.) Have you tried to get a price quote from anywhere else? (http://www.arthrex.com/products/AR-2285-10) Because they sometimes turn up on Ebay (http://www.ebay.com/itm/Arthrex-AR-2285-10-Parallel-Device-1...)

> but the blades get thrown out after just a single use

One reason for that, at least in the UK, and maybe this is historical, is because of diseases like CJD.

But as ISL said a sharp blade is a good blade and when you're slicing people you want the best blades you can get.

> Most of the other drugs cost between $40-60 per dosage.

In England everything is free at the point of delivery. Medications are a bit different. If you're in hospital they're free. Most people get exemptions from paying. The people who do pay need to pay about £7.50 per line item per month. There are discounts for people who need a lot of meds.

> The screws and washer are made out of titanium. I haven’t had any problems with MRIs or the metal detectors at the airport, but they do show up very clearly on my x-rays:

When my father died he had left me his artificial knees in his will. Luckily he had also asked to be cremated, so it was nice and easy to get them.

What I'm particularly curious about is why this market doesn't seem to work.

Insurance companies want customers to pay them. Insurance companies don't want to pay too much to hospitals because that's cutting the margins. So why don't insurance companies seem to be driving the costs down? Are insurance companies equipped to investigate the costs reported by hospitals?

Some kind of anonymised crowd-sourced data would let people know if their operation was around the same price as other people were paying. Perhaps you'd need to break the price down so people were able to compare similar things.

I hope your knee heals well and that you start to feel the benefit of that surgery!!