Cost Analysis of Outpatient Anterior Cruciate Ligament Reconstruction: Autograft versus Allograft

Abstract

BackgroundPrior studies suggest the cost of allograft anterior cruciate ligament (ACL) reconstruction is less than that for autograft reconstruction. Charges in these studies were influenced by patients requiring inpatient hospitalization.Question/purposeWe therefore determined if allograft ACL reconstruction would still be less costly if all procedures were performed in a completely outpatient setting.MethodsWe retrospectively reviewed 155 patients who underwent ACL reconstruction in an ambulatory surgery center between 2001 and 2004; 105 had an autograft and 50 had an allograft. Charges were extracted from itemized billing records, standardized to eliminate cost increases, and categorized for comparison. Surgeon and anesthesiologist fees were not included in the analysis. Groups were compared for age, gender, mean total cost, mean cost of implants, and several other cost categories.ResultsThe mean total cost was $5465 for allograft ACL reconstruction and $4872 for autograft ACL reconstruction. There were no differences in complications between the two groups.ConclusionsAllograft ACL reconstruction was more costly than autograft ACL reconstruction in the outpatient setting. The cost of the allograft outweighs the increased surgical time needed for harvesting an autograft.Level of Evidence Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

Revision of anterior cruciate ligament reconstruction with patellar tendon allograft and autograft: 2- and 5-year results

“…Nagda et al [34], however, found that the total treatment costs for autograft patients were lower owing to the high cost of the allograft.…”

The past, present and future in scaffold-based tendon treatments

“…Further, it has been suggested that mismatch in age, activity and body weight between donor and recipient may be crucial factors in the failure of allografts for ACL reconstruction [304]. In addition, the use of allografts is further limited by their higher overall surgical costs; approximately US$ 1,000 extra per clinical case [305,306]. For these reasons, the use of xenografts took off, with numerous products currently available [307,308].…”

Surgical Techniques for the Reconstruction of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review

“…Despite the abundance of operative techniques, there is still a need for less invasive surgical approaches that preserve soft tissue integrity and are more reproducible and less technically challenging than those currently available. [30][31][32][33][34] The purpose of this study was to systematically evaluate surgical reconstruction techniques of the MCL and posteromedial corner of the knee. We hypothesized that anatomic medial knee reconstruction would result in superior measures of valgus laxity and functional patient-reported outcomes when compared with other nonanatomic surgical techniques.…”