Trends in Anterior Cruciate Ligament Reconstruction in the United States

Abstract

Background:The anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee for which surgery is performed. United States national estimates of ACL reconstruction vary widely.Purpose:This study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the utilization of inpatient and ambulatory surgery for ACL tears in the United States.Study Design:Descriptive epidemiology study.Methods:The National Survey of Ambulatory Surgery, conducted in 1994, 1995, 1996, and 2006 (data from 1994, 1996, and 2006 were used in the study), and the National Hospital Discharge Survey, conducted between 1990 and 2007, were used to identify cases of ACL reconstruction. The data were analyzed for trends in demographics, treatment, and utilization.Results:Between 1994 and 2006, the population-adjusted estimate of the rate of ACL reconstructions increased by 37% (33.0/100,000 capita or 86,837 total procedures to 45.1/100,000 capita or 134,421 total procedures). There was an increase in the proportion of females undergoing reconstruction in both the ambulatory (30% to 40%) and inpatient (29% to 47%) settings over the study period, with a 304% increase in the sex-adjusted estimate of the rate of female ambulatory procedures between 1994 and 2006. Age-adjusted estimates of the rates of ambulatory ACL reconstruction increased among all age groups, with a 924% increase in patients less than 15 years of age. Concurrent meniscectomy remained relatively constant in the ambulatory (37% to 40%) and inpatient (37% to 33%) settings between 1994 and 2007. Private insurance was the largest compensator, representing 77% of cases in 2006. Between 1994 and 2006, the use of peripheral nerve blocks during ambulatory surgery increased from 0.7% to 30.8%.Conclusion:The rate of ACL reconstruction increased dramatically between 1990 and 2007 based on the National Survey of Ambulatory Surgery and National Hospital Discharge Survey databases, which represents the most up-to-date publicly available data. Knowledge of this increase and national practice patterns may aid policy makers and surgeons in appropriately allocating health care resources to ensure quality patient care.

Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015

“…We identified age and sex differences in the incidence of ACL reconstruction surgery, with the peak incidence in males being for a slightly older age group and 73% higher than the peak incidence in females. This is consistent with studies that have reported higher rates of ACL reconstruction in males, 2 , 18 , 19 despite females being two to ten times more likely to rupture their ACL when participating in high risk sports such as basketball and soccer 20 , 21 . It is conceivable that the higher incidence in males reflects greater participation in sports such as Australian rules football, in which pivoting, jumping and rapid deceleration increase the risk of ACL injury 22 .…”

Prevention and Management of Post-operative Complications Following ACL Reconstruction

“…There are an estimated 200,000 anterior cruciate ligament (ACL) reconstructions annually in the USA [1][2][3], with recent trends showing an increase in the incidence of ACL tears and subsequent reconstructions through epidemiological data [4]. Surgical reconstruction of the ACL is designed to restore the normal anatomy and biomechanics of the knee joint to allow individuals to return to their previous sport or work activity.…”

Technical Considerations in Revision Anterior Cruciate Ligament Reconstruction for Operative Techniques in Orthopaedics

“…As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, 1, 2 the rate of revision surgery continues to climb. Despite technical and rehabilitation advances in primary ACL surgery, the rate of re-tear remains higher than desired.…”