编辑评述：成本效益，直到不再如此：外侧关节外肌腱固定术技术的变异性挑战了前交叉韧带重建术的成本分析
简介
该研究探讨了在初次前交叉韧带重建（ACLR）中附加外侧关节外肌腱固定术（LET）的成本效益问题。关键发现：尽管现有证据表明LET可降低移植物失败率，尤其在年轻、高风险运动员中，且简化模型显示其具有成本效益，但移植物选择（如腘绳肌腱自体移植物 vs. 股四头肌腱或骨-髌腱-骨自体移植物）、固定方式（如缝线锚钉）、术者经验及患者风险因素的差异，导致实际成本难以标…
英文摘要
Lateral extra-articular tenodesis (LET) is an adjunct to anterior cruciate ligament reconstruction (ACLR) designed to improve rotational stability and reduce graft failure, particularly in young, high-risk athletes returning to pivoting sports. With growing clinical evidence supporting reduced failure rates, recent cost analyses suggest lateral extra-articular procedures at the time of primary ACLR may be cost-effective. In this context, routine LET begins to appear not only reasonable but financially responsible. Surgeons, patients, hospital systems, and insurers are understandably drawn to this promise of cost-effectiveness. However, variability in graft choice, fixation methods, surgeon experience, and patient risk profiles introduces cost differences that are difficult to standardize. Even small inefficiencies or complications can weaken the theoretical savings projected by simplified models. Routine LET may appear cost-effective under certain assumptions, principally alongside hamstring autograft ACLR. However, these conditions may not fully reflect contemporary ACLR practice across diverse surgical environments and patient populations. Until economic analyses incorporate current graft utilization patterns (i.e., quadriceps and/or patellar tendon autograft), varied fixation techniques (e.g., suture anchors), patient-specific indications, and the realities of surgical reproducibility, surgeons should approach recommendations for routine LET with scrutiny rather than automatic adoption.