Background - Multiple autograft choices are available for anterior cruciate ligament reconstruction (ACLR), however the ideal graft choice has not been determined. While there are technical differences, consideration of cost-driving factors that influence ACLR graft choice could help optimize value-based care. This study aims to evaluate the expenses associated with different graft choices for ACLR, considering demographic variables and graft cost.

Methods – A retrospective chart review was performed from January 2020 to August 2023 for patients undergoing primary ACLR at one health system. All adult patients who have undergone ACL repair surgery within this timeframe were included. Demographic data including sex, age, ethnicity, body mass index (BMI) was collected. Socioeconomic status (SES) was analyzed using median household income (MHI) and area deprivation index (ADI) based on patient addresses (UW-Madison). Graft type and costs were obtained from the electronic medical record. Multiple linear regressions and t-test analyses were performed.

Results – A total of 389 patients were included with 274 BTB grafts, 64 hamstring grafts, and 51 quad grafts. Mean cost of BTB graft was $3,730.35, hamstring graft was $3,491.43, and quad graft was $4,280.34. Both hamstring and quad grafts were significantly correlated with greater total costs (p=0.018) (p=0.006), while BTB grafts were not (p=0.232). no significant correlations were found between ADI, sex, race, age, insurance type, and smoking and total graft costs. BMI, however, was significantly associated with greater total supply costs (p=0.015).

Conclusion – Graft selection in ACLR was identified as a modifiable cost driver in this study, with hamstring grafts found to be significantly cheaper and quad grafts significantly more expensive. The average cost is highest when using a quad graft and lowest when using a hamstring graft. BMI also proved to be a contributor to costs in ACLR.