Relationship Between Age, Cost, and Patient Reported Outcomes in Primary ACLR:

Objectives: To evaluate how surgical trends, costs, and outcomes for anterior cruciate ligament reconstruction (ACLR) vary with patient age. Design: Retrospective Cohort Study Setting: Outpatient Ambulatory Surgery Center Patients: 587 primary ACLR patients from 2009-2016. Inclusion criteria consisted of ACLR, complete preoperative two-year post-operative reported outcome (PRO) data. Patients were excluded if they underwent non-operative management, multi-ligamentous repair, or sustained poly-trauma. Intervention: Main Outcome Measurements: failure/re-rupture, reoperation, cost care, Knee Injury & Osteoarthritis Score (KOOS) Single Assessment Numeric Evaluation (SANE). Results: Younger prevalently female compared to older (p<0.0001). Graft use varied according age, more commonly being treated allograft There equivalent rates meniscal injuries (p=0.0855), but treatment differed than age 25. Older on average received meniscectomies versus repairs (p=0.0009). Operative time was found be lowest in 40 older. Total implant, day-of-surgery, episode care costs significantly higher (respectively r=0.48, r=0.43, r=0.37; p<0.001). Re-rupture similar among groups, however younger reoperations (p=0.0349). While baseline KOOS SANE across ages (p<0.032), changes did not (p≥0.384). Conclusions: Patient characteristics, techniques, PROs change not. These results provide information can influence value the setting ACLR. Keywords: Anterior Cruciate Ligament Reconstruction, KOOS, SANE, Cost, TDABC, Value-Based Care Level Evidence: IV