The Societal and Economic Impact of the Anterior Cruciate Ligament Tear

What is the cost in both societal and economic impact of the anterior cruciate ligament tear?  Is there a difference in cost when comparing patients who have undergone an ACL reconstruction versus more conservative treatment?

cheerleading and sports injuries like an anterior cruciate ligament tear
An outstanding study published in the October 2013 issue of the Journal of Bone and Joint Surgery compared a cost analysis of an ACL reconstruction versus a structured rehab program. The authors, Drs. Richard Mather et al. found that in the short to intermediate term (6 years) ACL reconstruction was both less costly and more effective than rehab without reconstruction.

In the short term, the ACL reconstruction was $4,503 dollars less than structured rehab and in the long term the surgical group provided a savings of $50,417 dollars.

Effectiveness was expressed as quality – adjusted life years gained. The operative group had an improvement of .72 compared to the rehabilitation group.

Anterior Cruciate Ligament Tear – Reduce Costs Through ACL Reconstruction & ACL Injury Prevention


The authors concluded that the ACL reconstruction is the most cost effective treatment strategy for people suffering from an ACL tear. Based on this research, ACL reconstruction offers a reduction in societal costs when compared to rehabilitation, when indirect fctors including things like the ability to work and individual earnings are taken into consideration.

These findings underscore the substantial cost of an ACL tear over a lifetime. It is advisable that more resources should be directed to creating innovations that help reduce the number of ACL injuries that happen every year.

The authors stated that two primary conclusions should be drawn from this analysis.

  1. The indirect costs of an ACL injury are great in a patient with an unstable knee. These are based on lost wages, declines in productivity, and the effects of disability.
  2. An unstable knee is more likely to develop osteoarthritis and that has a substantial cost associated with it. Based on the 200,000 ACL reconstructions performed per year in the United States, the authors calculated that the cost of the ACL injuries that are treated without surgery would result in $4.24 billion compared to the $2.78 billion from the surgical group.

We know that patients that have an anterior cruciate ligament tear, whether they have surgery or not, are more likely to develop osteoarthritis post injury. Some studies quote an incidence of osteoarthritis up to 80% in this population. There needs to be intense  and continued focus on ACL prevention strategies  such as the use of the PEP program (the Santa Monica ACL prevention program) and other ACL prevention programs so the injury rates can be reduced.

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