Background Total knee arthroplasty (TKA), partial knee arthroplasty (pKA), and arthroscopic meniscectomy are among the most commonly performed procedures for knee osteoarthritis and degenerative meniscal tears in the United States, yet concerns persist regarding overuse, variable clinical benefit, and high costs. Orthobiologic treatments, including platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), have emerged as less invasive alternatives, but downstream health care resource use (HCRU) and costs associated with these treatments relative to surgery are not well established.

Methods We conducted a retrospective, observational cohort study using linked commercial insurance claims data and a national orthobiologic treatment registry to compare downstream HCRU and costs following orthobiologic versus surgical treatment of knee conditions. Two comparisons were evaluated separately: (1) PRP versus arthroscopic meniscectomy among patients with degenerative meniscal pathology and minimal osteoarthritis, and (2) BMAC with or without PRP versus TKA or pKA among patients with knee osteoarthritis. Eligible procedures occurred between 2016 and 2023. Propensity score matching was used to balance demographic and clinical confounders. Co-primary outcomes were total health care costs at 12 and 24 months post-procedure, with exploratory analyses at 36 and 48 months. Costs were estimated using multiple approaches, including Medicare-based estimates, commercial payer estimates, and aggregate allowed amounts. HCRU outcomes included outpatient visits, physical therapy, imaging, opioid use, repeat injections, and subsequent surgery.

Results After matching, analyses included 167 PRP-treated patients matched to 1,670 meniscectomy patients and 165 BMAC/PRP-treated patients matched to 1,650 TKA/pKA patients, with good balance across pre-specified confounders. Progression to subsequent surgery after orthobiologic treatment was rare at 12 and 24 months in both cohorts. Compared with TKA/pKA, BMAC/PRP was associated with lower overall health care use for several services, including outpatient visits, physical therapy, knee radiographs, and opioid prescriptions, although magnetic resonance imaging was more frequent following orthobiologic treatment. Total costs at 12 and 24 months were consistently higher for TKA/pKA than for BMAC/PRP across all costing methods. In the PRP versus meniscectomy comparison, differences in health care use were modest, and costs were similar or lower for PRP depending on the costing approach. Exploratory analyses through 48 months showed similar patterns, with persistently low rates of subsequent surgery after orthobiologic treatment and generally higher cumulative costs following surgical intervention.

Conclusions In this real-world, propensity-matched analysis of commercially insured patients, orthobiologic treatments with PRP or BMAC were associated with similar or lower downstream health care costs compared with commonly performed surgical alternatives for selected patients with degenerative meniscal tears or knee osteoarthritis. Progression to surgery following orthobiologic treatment was uncommon through two years and remained low in longer-term exploratory analyses. These findings support the consideration of orthobiologic therapies as potentially lower-cost alternatives to surgery for appropriately selected patients and may inform shared decision-making and payer policy.

Dr. Centeno is employed by Regenexx. This study was sponsored by Regenexx. The sponsor had no role conduct of the analysis or interpretation of the data, manuscript preparation, or the decision to submit the manuscript for publication. Duke University investigators had full access to all study data and retained final responsibility for the content of the manuscript and the decision to submit for publication.

This study was sponsored by Regenexx. The sponsor had no role conduct of the analysis or interpretation of the data, manuscript preparation, or the decision to submit the manuscript for publication. Duke University investigators had full access to all study data and retained final responsibility for the content of the manuscript and the decision to submit for publication. We wish to acknowledge support from the Biostatistics, Epidemiology and Research Design (BERD) Methods Core funded through Grant Award Number UL1TR002553 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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The Duke University IRB gave ethical approval for this work (Pro00116431).

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