Single-Stage Revision Anterior Cruciate Ligament Reconstruction Requires Significantly Longer Operative Time Than Primary Reconstruction, Despite Comparable Reimbursement: A Single-Center Study
DOI:
https://doi.org/10.55576/job.v6i3.90Keywords:
relative value units, RVU, revision anterior cruciate ligament reconstruction, revision ACL-R, operative time, CPT, ACL reconstruction, revision, reimbursement, healthcare economicsAbstract
Objectives: To evaluate labor and time investment for revision ACL-R procedures, assess billing versus reimbursement disparities, and compare value returned, controlling for time and relative value units (RVUs), between revision and primary ACL-R procedures.
Design: Retrospective cohort study
Setting: Academic Private Practice
Patients/Participants: Patients who underwent primary ACL-R and single-stage revision ACL-R at a single academic institution from 2010 to 2021.
Intervention: Primary ACL-R and single-stage revision ACL-R
Main Outcome Measures: Patient demographics, operative variables, CPT codes, RVUs, billed charges, and final reimbursements were collected and compared between groups.
Results: Of 57 patients, 42 (73.7%) underwent primary ACL-R and 15 (26.3%) underwent revision ACL-R. Revision procedures had significantly longer operative times (159.7±62.4 vs 111.6±32.2 minutes, p<0.001). Revision procedures generated numerically higher RVUs (49.5±13.3 vs 44.1±12.7, p=0.14) and similar RVU efficiency per minute (0.4±0.2 vs 0.4±0.1, p=0.192). Reimbursement per operative minute was numerically lower for revision procedures ($18.5±$10.1 vs $24.9±$16.2), but the difference was not statistically significant (p=0.143). Total reimbursement was comparable between groups ($2,671.4 vs $2,689.1, p=0.972).
Conclusion: Single-stage revision ACL-R required approximately 43% longer operative time than primary procedures (p<0.001) yet generated comparable total reimbursement. Although reimbursement per operative minute was numerically lower for revision procedures, this difference did not reach statistical significance in this small revision cohort (n=15). These findings suggest that a shared CPT code may not fully capture the added time and complexity of revision procedures.
Key Terms: relative value units, RVU, revision anterior cruciate ligament reconstruction, revision ACL-R, operative time, CPT, ACL reconstruction, revision, reimbursement, healthcare economics
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Copyright (c) 2026 George Graham, Anna Maria Ifarraguerri, Calvin Chandler, Alexander White, Caleb Lifsey, Kennedy Gachigi, Dana Piasecki, James Fleischli, Bryan Saltzman
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