Epidemiology of Surgical Treatment of Youth Sports Injuries in the United States

Abstract

Objectives:There is concern that the number of youth sports injuries are increasing in the United States. The purpose of our study was to utilize a large national database to characterize the incidence of surgical procedures for various pediatric sports orthopedic injuries as well as trends amongst certain patient populations.Methods:A search of the Truven Health MarketScan Database (over 39 million patients per year) was conducted to identify the incidence of various orthopaedic conditions as well as associated surgical procedures from 2008 through 2014 amongst patients 10-19 years of age. The database was searched for patients who had International Classification of Disease (ICD-9) codes and Current Procedure Terminology (CPT) codes for operative treatment for the following conditions: anterior cruciate ligament (ACL) injuries, knee collateral ligament injuries, chondral injuries, Osgood-Schlatter syndrome, and elbow ulnar collateral ligament (UCL) injury. Patients identified were characterized by gender, age, and year of injury as well as surgery. Regression analysis was used to evaluate differences in surgery trends between individual patient groups delineated by age, and gender. The Cochran-Armitage trend test was used to identify significant differences in surgery trends seen yearly.Results:A total of 660,982 patients sustained an injury with 165,590 (25%) having related surgery during the study period. Surgery was performed for 65,224 (54.4%) patients for ACL injury, 3,839 (3.7%) patients for knee collateral ligament injury, 91,217 (30.6%) patients for chondral injury, 211 (0.2%) patients for Osgood-Schlatter syndrome, and 5,099 (22.71%) patients for UCL injury. Only knee collateral ligament injuries demonstrated an increase in the rate of surgical intervention over time, from 2% in 2008 to 5.3% in 2014 (p < .0001). Age greater than 15 yrs was associated with a higher likelihood for surgical intervention for all diagnoses (p < .001). Average age of surgical intervention ranged from 15.9 yrs for Osgood-Schlatter syndrome to 16.8 yrs for a UCL injury and did not change for any diagnosis over time. Females were more likely to undergo surgery for ACL injuries (OR = 1.5, p < .0001), knee collateral ligament injury (OR = 1.7, p < .0001), and Osgood-Schlatter syndrome (OR = 1.8, p < .0001) while males were more likely to undergo surgery for chondral injuries (OR = 1.6, p < .0001) and UCL injuries (OR = 1.1, p < .0005). Both male and female patients demonstrated a sustained increase in surgery for knee collateral ligament injuries over the study period, with no other diagnosis showing trend changes secondary to gender.Conclusion:Our study found the incidence of surgical treatment of five common sports injuries remained stable over time with only knee collateral ligament injuries demonstrating an increase in surgical incidence over the study period. There was no significant change over time in the average age of surgical intervention for all diagnosis. Females were more likely to undergo surgery for ACL injuries, knee collateral ligament injuries, and Osgood-Schlatter syndrome while males were more likely to undergo surgery for chondral and UCL injuries. Despite concern that incidence of youth sports injuries and surgeries are increasing over time and that average age of these injuries is decreasing, our data using a large US National Database does not support this.