A Cost-Effectiveness Analysis of the Addition of Autograft Lateral Extra-Articular Procedures to Primary Anterior Cruciate Ligament Reconstruction

Background: Multiple clinical studies have highlighted the improved outcomes of ACLR in associated with LEAPs. However, such procedures are associated with increased costs and operating room time, thus questioning their cost-effectiveness. Purpose: To evaluate the cost-effectiveness of augmenting an anterior cruciate ligament reconstruction (ACLR) with autograft lateral extra-articular procedures (LEAP), either a modified Lemaire or anterolateral ligament reconstruction. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: A cost-effectiveness analysis was developed using failure rates for ACLR with and without concomitant autograft LEAPs from existing level 1 and 2 studies. Institutional data were used to estimate costs, including hospital and surgeon fees for ACLR and additional implant costs for LEAP. Utility measures were derived by linear approximation of the European Quality of Life 5 Dimension from the Knee injury and Osteoarthritis Outcome Score to evaluate improvements in quality-adjusted life years (QALY), a standardized metric that combines quantity and quality of life into a single value, over 1 year. Cost-effectiveness was determined based on previous literature, with an intervention considered cost-effective if the incremental cost-effectiveness ratio (ICER) was