Tibialis Anterior or Posterior Allograft Anterior Cruciate Ligament Reconstruction Versus Hamstring Autograft Reconstruction: An Economic Analysis in a Hospital-Based Outpatient Setting

Purpose: To analyze and compare the direct costs, reimbursement rates, gross contribution margins, and operating room and recovery room times for anterior cruciate ligament (ACL) reconstructions with the use of soft-tissue allografts and autografts. We aimed to determine the financial impact of using allograft tissue for ACL reconstruction in a hospital-based outpatient setting. Methods: Financial data from the facility billing database and operating room (OR) reports from the electronic medical record were queried to identify all patients undergoing arthroscopic ACL reconstruction during a 12-month period. A subset of patients who had isolated ACL reconstruction with or without simple meniscectomy or chondral debridement was identified as the study group. We compared 46 ACL reconstructions using tibialis anterior or posterior allografts and 50 ACL reconstructions using hamstring autografts. Facility direct cost, reimbursement rates, gross contribution margin, OR times, and other variables were compared. Results: The facility mean direct cost for ACL reconstruction using allografts was $4,587, with a mean OR time of 92 minutes. The mean direct cost and OR time for ACL reconstruction using autografts were $3,849 and 125 minutes, respectively. Allograft ACL reconstructions were $738 more costly, and reimbursement was also higher. Allograft ACL reconstruction produced a 41.5% margin with a gross contribution margin of $3,248, whereas autografts had a reimbursement rate with a 45% margin with a gross contribution margin of $3,156. Conclusions: In this study the cost of allograft tissue used in ACL reconstruction was not offset by the savings realized from shorter OR and recovery room times. However, in a hospital-based outpatient setting, reimbursement covered the cost of the allograft, offsetting the additional expense. Level of Evidence: Level III, retrospective comparative study for economic analysis.