Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017

Abstract

ObjectivesWe investigated the temporal trend and the geographical variation in the rate of an anterior cruciate ligament (ACL) reconstruction and meniscal repair (MR) performed in England during a 20-year window.MethodsAll hospital episodes for patients undergoing ACL reconstruction or MR between 1 April 1997 and 31 March 2017 were extracted by procedure code from the national hospital episode statistics. Age-standardised and sex-standardised rates of surgery were calculated using Office for National Statistics population data as the denominator and analysed over time both nationally and regionally by National Health Service clinical commissioning group (CCG).ResultsBetween 1997–1998 and 2016–2017, there were 133 270 cases of ACL reconstruction (124 489 patients) and 42 651 cases of MR (41 120 patients) (isolated or simultaneous). Nationally, the rate of ACL reconstruction increased 12-fold from 2.0/100K population (95% CI 1.9 to 2.1) in 1997–1998 to 24.2/100K (95% CI 23.8 to 24.6) in 2016–2017. The rate of MR increased more than twofold from 3.0/100K (95% CI 2.8 to 3.1) in 1997–1998 to 7.3/100K (95% CI 7.1 to 7.5) in 2016–2017. Of these cases, the rate of simultaneous ACL reconstruction and MR was 2.6/100K (95% CI 2.5 to 2.8) in 2016/2017. In 2016–2017, for patients aged 20–29, the sex-standardised rate of ACL reconstruction was 76.9/100K (95% CI 74.9 to 78.9) and for MR was 19.8/100K (95% CI 18.8 to 20.9). Practice varied by region—in 2016–2017, 14.5% (30/207) of the CCGs performed more than twice the national average rate of ACL reconstruction and 15.0% (31/207) performed more than twice the national average rate of MR.ConclusionsThe rate of ACL reconstruction (12-fold) and MR (2.4-fold) has increased in England over the last two decades. There is variation in these rates across geographical regions and further work is required to deliver standardised treatment guidance for appropriate use.

The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

“…Meniscal repair has become a standard procedure accompanying ACLR over the last 2 decades [7,8]. Generally, it was shown that the outcome of meniscal repair performed at the same time as ACLR has better results than meniscal repair alone [9,10].…”

Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury?

“…The inclusive youth age window of ~ 6 to 25 is intended to overlap between periods when ACL injury prevalence and incidence are high and when youth are undergoing a state of heightened CNS plasticity. Data from the United Kingdom and Sweden show that ACL surgical repairs are most often performed in patients aged 20-29 [2,3]. However, surgical rates in patients under 20 years old are rapidly increasing, with reports from 1997 to 2017 indicating more than a 20-fold increase [2].…”

“…Data from the United Kingdom and Sweden show that ACL surgical repairs are most often performed in patients aged 20-29 [2,3]. However, surgical rates in patients under 20 years old are rapidly increasing, with reports from 1997 to 2017 indicating more than a 20-fold increase [2]. The age window of surgical interventions for ACL injury is further modulated by sex.…”

Physiotherapy treatment and rehabilitation following anterior cruciate ligament injury in New Zealand: Are we doing enough?

“…The exact incidence of ACL injury is not known as not all ACL injuries are diagnosed or proceed to surgery (Janssen, Orchard, Driscoll, & Van Mechelen, 2012). ACL surgical rates are often used as surrogate estimates of injury rates (Moses, Orchard, & Orchard, 2012;Sanders, Maradit Kremers, Bryan, Larson, et al, 2016), with rates of ACLR increasing worldwide (Abram, Price, Judge, & Beard, 2019;Sanders, Maradit Kremers, Bryan, Larson, et al, 2016;Zbrojkiewicz, Vertullo, & Grayson, 2018). An increasing ACLR rate is associated with increased work absenteeism, rehabilitation costs and an increased rate of degenerative knee conditions and knee joint arthroplasty (Barenius et al, 2014;Cinque, Dornan, Chahla, Moatshe, & LaPrade, 2017;Janssen et al, 2012;Khan et al, 2018;Suter et al, 2017).…”