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Management of anterior cruciate ligament injury in lower-middle income countries

Focus on outcomes and health economics in Indonesia
PhD ceremony:Mr R. (Romy) Deviandri
When:October 04, 2023
Supervisors:dr. I. (Inge) van den Akker-Scheek, prof. dr. M.J. (Maarten) Postma
Co-supervisors:dr. H.C. van der Veen, dr. A. Andri MT Lubis
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Management of anterior cruciate ligament injury in lower-middle
income countries

Anterior cruciate ligament (ACL) injury is a common sport-related knee injury. In Indonesia, where there are 274 million people, numbers are thought to be close to one million per year. This thesis aims to contribute to the improved management of ACL injuries in lower-middle income countries (LMICs) by providing outcome assessment tools for monitoring patients with ACL injuries and evaluating ACL treatment in Indonesia from a health-economic point of view. The first part of this thesis focuses on translating and studying the clinimetric properties of patient-reported outcome measures (PROMs) for monitoring the treatment outcomes of ACL injury in the Indonesian-speaking population. The second part of this thesis elaborates on the health-economic aspect of ACL injury, focusing on Indonesia.In Part 1, PROMs for monitoring patients with ACL injury are adapted to the Indonesian-speaking population. This thesis provided the Indonesian translated versions of the IKDC, Lysholm, Tegner, and ACL-RSI scales. It was concluded that all of those scales can be considered valid and reliable, and show good responsiveness for monitoring Indonesian-speaking patients with ACL injury over time.In Part 2, the health-economic aspects of ACL injury treatment are elaborated on, focusing on health economics in Indonesia. A decision tree model was constructed for cost-utility analysis of early ACL reconstruction surgery (ACLR) versus conservative treatment. It is concluded that early ACLR does not seem to be a more cost-effective strategy than conservative treatment for Indonesian ACL injury patients – the opposite of what is shown in many developed countries.