Lateral Extra‐articular Tenodesis is Cost‐Effective at the Time of Primary Hamstring Autograft Anterior Cruciate Ligament Reconstruction in High‐Risk Patients

PURPOSE: To perform breakeven analysis to assess the cost-effectiveness of performing lateral extra-articular tenodesis (LET) at the time of hamstring autograft primary anterior cruciate ligament reconstruction (ACLR) in high-risk patients. METHODS: Baseline costs for ACLR, ACLR with LET (ACLR-LET), revision ACLR, and initial failure rate were collected from the literature. Two initial failure rates following hamstring autograft ACLR without LET in high-risk patients were used based on a previous study: the rate of revision surgery (11%) and the rate of clinical failure due to rotatory instability (40%). Breakeven economic analysis was used to assess the cost-effectiveness of adding LET to primary ACLR. To account for the variability in cost, initial failure rates, and procedural differences across institutions, a wide range of values were used to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) to achieve cost-effectiveness. RESULTS: Assuming primary ACLR cost of $20,840, ACLR-LET cost of $27,405, and revision ACLR cost of $35,205, primary LET is cost-effective at initial failure rates exceeding 18.7% (ARR = 0.187, NNT = 5). Assuming a 40% failure rate, LET is cost-effective when revision surgery costs are greater than $16,412 (ARR = 0.400, NNT = 3) or when primary ACLR-LET costs less than $39,422 (ARR = 0.400, NNT = 3). When assuming a failure rate of 11%, LET is cost-effective when revision surgery costs exceed $59,700 (ARR = 0.110, NNT = -9) or when primary ACLR-LET is no greater than $24,712 (ARR = 0.110, NNT = 10). CONCLUSIONS: Primary LET is a cost-effective intervention for a wide range of primary and revision surgery costs according to this breakeven economic analysis. Using surgical cost estimates from literature, LET is cost-effective when the initial failure exceeds 18.7%, or when revision surgery exceeds $16,412, which is greater than reported in current literature, thus indicating the clinical and economic benefits of primary LET in high-risk patients undergoing hamstring autograft ACLR. LEVEL OF EVIDENCE: Level IV, economic analysis.