Article Abstract

Allograft augmentation of hamstring autografts was not a cost-effective treatment option for middle aged patients undergoing primary anterior cruciate ligament reconstruction

Authors: Cale A. Jacobs, Chaitu S. Malempati, Eric C. Makhni, Darren L. Johnson


Background: By lessening the rate of graft failure, augmentation of hamstring autografts with semitendinosus allograft tissue has been demonstrated to provide a cost-effective treatment option for adolescent anterior cruciate ligament reconstruction (ACLR) patients. However, with the overall rate of graft failure being much lower in older patients, it remains unclear if these so-called hybrid hamstring grafts are a cost-effective option in the middle-aged patient population. We hypothesized that hybrid hamstring grafts would not result in a clinically meaningful reduction in the prevalence of graft failure and, as such, would not be a cost-effective treatment option for middle-aged patients.
Methods: We retrospectively identified patients ≥25 years of age that had undergone ACLR by a single surgeon between 2010 and 2015. Patient demographics, graft type, and the need for secondary surgical procedures were compared between hamstring autografts (HAM) and hamstring autografts augmented with semitendinosus allograft tissue (HYBRID). The clinical results were then used to assess the potential cost effectiveness of HYBRID grafts in this group of middle-aged ACL patients.
Results: There were a total of 288 patients (HAM = 138, HYBRID = 150). The rate of graft failure did not differ between groups (HAM = 3/138, 2.2% vs. HYBRID = 4/150, 2.7%, P>0.99). The cost-effectiveness analysis demonstrated that the HAM graft provided incremental cost savings of $1,322.39 compared to the HYBRID graft, and the HAM graft was the preferred strategy in 85% of cases.
Conclusions: In younger patients, the initial cost of allograft augmentation is offset by a significant reduction in graft failure; however, similar findings were not realized in series of middle-aged patients. This information can assist surgeons as the both the techniques and patient selection criteria for hybrid grafts continues to evolve.