Decreasing Incidence of Anterior Cruciate Ligament Tears, Increasing Utilization of Anterior Cruciate Ligament Reconstruction in the United States from 2010-2020

Abstract

The present study aimed to characterize the incidence of anterior cruciate ligament (ACL) tears, ACL reconstruction (ACLR), and ACL non-operative management from 2010-2020, stratifying by age, biological sex, and Charlson Comorbidity Index (CCI) score. A retrospective cohort analysis was performed using the PearlDiver national insurance claims database. Cohorts of patients with ACL tears, ACLR, and non-operative management were identified using ICD-9/10, and CPT codes between 2010-2020. All patients with ACL tears were included. Patients were stratified by age, sex, and CCI. Compound Annual Growth Rate (CAGR) analysis, T tests, and Cohen's d tests were performed to analyze trends and demographic variables. Of 931,186 ACL tears during the study period, 196,589 were managed with ACLR and 734,597 were managed non-operatively. The cumulative incidence of ACL tears was 75.19 tears per 100,000 person-years. There was a modest decrease in the incidence of ACL tears, ACLR, and non-operative management from 2010-2020, with CAGRs of -3.43%, -3.55%, and -5.35%, respectively. The relative utilization of ACLR compared to non-operative management increased from 2010-2020 (CAGR 2.15%). Patients aged 10-19 accounted for the majority of ACL tears (22.31%) and ACLRs (30.97%). A slight majority of ACL tears (51.2%, p<0.001), ACLR (50.7%, p<0.001), and ACL tears with non-operative management (51.6%, p<0.001) occurred in female patients. The mean CCI of patients who underwent ACLR (mean=0.32; SD=0.77) was significantly lower than that of the general ACL tear cohort (mean=0.54; SD=1.19; p=0.005), and the non-operative management cohort (mean=0.64; SD 1.32; p=0.0004). The overall decrease in ACL tears, ACLR, and non-operative management found in this study is a reversal from trends reported in the literature from previous decades. 4 (Retrospective Case Series).