2025 ISAKOS Biennial Congress ePoster
The Cost-Effectiveness Of Lateral Extra-Articular Tenodesis In Primary Anterior Cruciate Ligament Reconstruction
Nathan Varady, MD, MBA, New York, NY UNITED STATES
Jacob F. Oeding, MS, Rochester, Minnesota UNITED STATES
Paul Inclan UNITED STATES
Andrew D. Pearle, MD, New York, NY UNITED STATES
Anil S. Ranawat, MD, New York, NY UNITED STATES
Sabrina M. Strickland, MD, New York, NY UNITED STATES
Scott A. Rodeo, MD, New York, NY UNITED STATES
Riley J. Williams, MD, New York, NY UNITED STATES
Hospital for Special Surgery, New York, NY, UNITED STATES
FDA Status Not Applicable
Summary
In this Markov chain Monte Carlo based analysis, lateral extra-articular tenodesis (LET) augmentation to primary anterior cruciate ligament reconstruction was found to be highly cost-effective in the vast majority of clinical scenarios.
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Abstract
Background
Recent data have demonstrated favorable outcomes following anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) augmentation. However, the cost-effectiveness of this procedure compared to ACLR alone is unclear. The purpose of this study was to evaluate the cost-effectiveness of ACLR with LET augmentation in athletes with primary ACL ruptures compared to treatment with ACLR alone.
Methods
A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 athletes undergoing ACLR+LET (iliotibial band) compared to ACLR alone. Costs, utility values, graft failure rates, and transition probabilities were derived from existing literature. Targeted meta-analysis of failure rates and patient reported outcomes was performed. Model outcomes included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses assessed the cost-effectiveness of ACLR+LET across a range of clinical scenarios.
Results
Meta-analysis demonstrated a weighted graft failure rate of 5% (95% CI: 3%-9%) for ACLR+LET compared to 11% (95% CI: 7%-18%) for ACLR alone (relative risk 0.39, 95% CI: 0.27-0.57, p<0.001). Across a five-year treatment horizon, the mean total cost of ACLR alone was $68,605 ± $9,472 compared to $56,217 ± $7,349 for ACLR+LET. ACLR+LET was associated with an additional 1.88 ± 0.30 QALYs compared to 1.54 ± 0.30 QALYs for ACLR alone, and ACLR+LET was determined to be the preferred treatment in 98.1% of patients in the microsimulation model. In sensitivity analysis, ACLR+LET remained the most cost-effective treatment strategy with an ACLR+LET failure rate up to 11.3% or an ACLR alone failure rate down to 4.8%.
Conclusion
LET augmentation is a cost-effective treatment option for athletic patients undergoing primary ACLR. The results of this Monte Carlo microsimulation suggest that ACLR+LET yields both superior outcomes and lower overall costs than ACLR alone. In sensitivity analysis, we found that only small improvements in graft failure rates were required for LET augmentation to be the favored treatment, suggesting that LET may be a cost-effective treatment option when used even beyond the highest risk athletes.