Cost comparison of anterior cruciate ligament reconstruction: Autograft versus allograft

Purpose: To compare the economic costs associated with anterior cruciate ligament (ACL) reconstruction using either autograft or allograft. The surgical costs are reported, including charge categories, for each procedure. All operations were performed in the Southern United States of America. Type of Study: Evaluation of cost data collected from a group of patients participating in a prospective, nonrandomized trial. Methods: A total of 122 patients with ACL-deficient knees undergoing surgical reconstruction using either bone-patellar tendon-bone autograft (n = 86) or freeze-dried Achilles tendon allograft (n = 37) were analyzed (1 patient underwent 2 altograft reconstructions). Patient selection for groups was based on the physician performing the surgery (2 surgeons performed autografts and 1 performed allografts). Groups were compared with respect to age, sex, race, and occupation. Hospital charge data were retrieved from the billing department and divided into various categories for comparison of the 2 groups. Results: The mean hospital charge for ACL reconstruction was $4,622 for allograft and $5,694 for autograft (P < .0001). Differences included increased operating room time and a greater likelihood of overnight hospitalization for autograft procedures. This was slightly offset by higher charges for operating room supplies for allograft reconstructions owing to the cost of the graft itself. Conclusions: Allograft reconstruction of the ACL was significantly less expensive than autograft bone-patellar tendon-bone reconstruction. Allograft ACL reconstruction is a less costly alternative to autograft reconstruction. Level of Evidence: Level IV, economic analysis with no sensitivity analysis.