A Descriptive Analysis Of Knee Surgeries In The U.S. Army From 2017-2020

Abstract

Musculoskeletal injuries (MSI) are the primary cause of disability discharge from active-duty military service. MSI of the knee joint often require surgical intervention, and anterior cruciate ligament injuries alone cost the military health system over $300-million annually. Identifying opportunities to reduce healthcare costs associated with knee surgeries, and focusing resources on improving post-surgery outcomes, requires a contemporary understanding of knee surgery incidence as it relates to surgery type and post-surgical care. PURPOSE: To identify the frequency and type of knee surgeries performed on Army personnel between 2017 and 2020, and to describe post-operative injury outcomes related to surgical procedure type and post-surgical care. METHODS: Data were obtained from the Soldier Performance, Health, and Readiness Database (SPHERE) and were processed using R to generate descriptive statistics. RESULTS: A total of 7,596 Soldiers (88% male) had a first-incident knee surgery between the observed dates, and the majority of the cohort held combat-related occupations (32%). The most common procedure was meniscus repair (39%), followed by ligament repairs (15%), and then articular debridement (11%). Multiple procedures on the same date occurred in 27% of the cases, and 11% of the Soldiers had more than one surgery within the observed period. From the time of surgery until the end of the data collection, 71% sustained a subsequent lower extremity or lumbar spine injury. The average time from surgery to first post-operative injury event was 7.3 months. A total of 3,896 Soldiers were discharged from active-duty service, 39% of which was due to knee-related disability. CONCLUSIONS: Meniscus repair was the most frequent knee surgery performed in the Army, and over one-quarter of the Soldiers who had a knee surgery had more than one type of procedure done. A majority of post-operative Soldiers sustain a subsequent injury after returning to duty, and more than one-third were discharged from active-duty service. Future studies should investigate ways to better support these at-risk Soldiers in order to improve their post-surgical outcomes.