Patient-level Value Analysis in Anterior Cruciate Ligament Reconstruction: A Practical Application Over a 2-year...

Patient-level value analysis (PLVA) demonstrates promise in measuring value, or outcomes achieved per dollar spent, of interventions such as orthopedic sport surgeries. Despite prior applications, PLVA has never been implemented in anterior cruciate ligament (ACL) reconstruction (ACLR). The purpose of this study was to apply PLVA in the setting of an ACLR 2-year episode of care and identify factors that influence value.

The patient-reported outcome measure (PROM) database of an ambulatory surgical center was queried for ACLR procedures from 2009 to 2022. Any procedure that was not a unilateral single-ligament primary ACLR for acute ACL injury (<6 months) or that lacked PROM data was excluded. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Single Assessment Numerical Evaluation (SANE) were used. Costs of care were quantified using time-driven activity-based costing (TDABC), adjusting for 2024 US dollars. Primary outcome of interest was 2-year value quotient, the ratio of 2-year change in KOOS to the TDABC total costs of care (V_KOOS).

In total, 491 patients and 24 surgeons were analyzed. Total costs of care correlated poorly with 2-year change in KOOS (r = 0.14) and SANE (r = 0.13). Factors associated with 2-year value included operative time, concomitant meniscal repair, graft type, and implants (all P ≤ .038). Allograft ACLR exhibited lower V_KOOS (P = .003) compared to autografts.

PLVA quantified 2-year value and identified influential institutional factors in the context of primary ACLR. Increased costs of care did not achieve improved outcomes. This methodology should be further implemented and researched in orthopedics.