Incidence Of Anterior Cruciate Ligament Reconstruction Research Articles

Trends in Pediatric Anterior Cruciate Ligament Reconstruction in Australia: An Analysis of Australian Medicare Benefits Schedule Database From 2001 to 2020.

Anterior cruciate ligament (ACL) injuries are common and increasingly prevalent in the pediatric population. However, there remain sparse epidemiological data on the surgical treatment of these injuries. The objective of this study is to assess the trends in the rate of pediatric ACL reconstruction in Australia over the past 2 decades. The incidence of ACL reconstruction from 2001 to 2020 in patients 5 to 14 years of age was analyzed using the Australian Medicare Benefits Schedule (MBS) database. Data were stratified by sex and year. An offset term was introduced using population data from the Australian Bureau of Statistics to account for population changes over the study period. A total of 3719 reconstructions for the management of pediatric ACL injuries were performed in Australia under the MBS in the 20-year period from 2001 to 2020. There was a statistically significant annual increase in the total volume and per capita volume of pediatric ACL reconstructions performed across the study period ( P <0.0001). There was a significant increase in the rate of both male and female reconstructions ( P <0.0001), with a greater proportion of reconstructions performed on males (n=2073, 56%) than females (n=1646, 44%). In 2020, the rate of pediatric ACL reconstructions decreased to a level last seen in 2015, likely due to the effects of COVID-19. The incidence of ACL reconstruction in skeletally immature patients has increased in Australia over the 20-year study period. This increase is in keeping with evidence suggesting poor outcomes with nonoperative or delayed operative management.

Healthcare Disparities in Orthopaedic Surgery: A Comparison of Anterior Cruciate Ligament Reconstruction Incidence Proportions With US Census-Derived Demographics.

Disparities exist and affect outcomes after anterior cruciate ligament (ACL) injury. The purpose of this study was to investigate the association between race, ethnicity, and insurance type on the incidence of ACL reconstruction in the United States. The Healthcare Cost and Utilization Project database was used to determine demographics and insurance types for those undergoing elective ACL reconstruction from 2016 to 2017. The US Census Bureau was used to obtain demographic and insurance data for the general population. Non-White patients undergoing ACL reconstruction with commercial insurance were more likely to be younger, male, less burdened with comorbidities including diabetes, and less likely to smoke. When we compared Medicaid patients who had undergone ACL reconstruction with all Medicaid recipients, there was an under-representation of Black patients and a similar percentage of White patients undergoing ACL reconstruction (P < 0.001). This study suggests ongoing healthcare disparities with lower rates of ACL reconstruction for non-White patients and those with public insurance. Equal proportions of patients identifying as Black undergoing ACL reconstruction as compared with the underlying general population suggests a possible narrowing in disparities. More data are needed at numerous points of care between injury, surgery, and recovery to identify and address disparities.

Anterior cruciate ligament reconstruction and concomitant procedures in Finland between 2004 and 2018 based on national registers.

We aimed to assess the incidence of anterior cruciate ligament reconstruction (ACLR) and concomitant procedures in Finland. We identified all the patients who underwent ACLR between 2004 and 2018 in Finland using national registry data. Patients with an ICD-10 diagnosis code S83.5 and the NOMESCO operation codes NGE30 or NGE35 were included. We recorded the patient's age, sex, Charlson comorbidity index, and concomitant procedures. NGE30 or NGE35 was defined as the main procedure and all other procedures attached to this procedure were included as concomitant procedures. Our study included 37,224 ACLRs. The overall incidence of ACLR was 46 (95%CI 34-62) per 105person-years. This increased from 38 per 105person-years in 2004 to its peak of 53 in 2014 before decreasing to 47 by 2018. Male patients had a higher overall incidence of ACLR than female patients (61 [CI 47-78] vs. 32 [CI 22-45] per 105person-years, respectively). However, this difference changed over time: for the males, a decrease in ACLR incidence was observed after 2014, whereas for the females, the trend increased throughout the study period. For both sexes, the highest incidence of ACLRs was in the age group 16-29 years (159 and 71 per 105person-years, respectively). Concomitant procedures were performed at the time of ACLR in 32% of cases. While the total incidence of ACLR decreased slightly from 2014 to 2018, it increased among women over the full study period, which might be due to increased female participation in contact sports. Special attention should be given to girls' and women's ACL rupture prevention and treatment.

Posterior Horn Lateral Meniscal Oblique Radial Tear in Acute Anterior Cruciate Ligament Reconstruction Incidence and Outcomes After All-Inside Repair: Clinical and Second-Look Arthroscopic Evaluation

Background: The term posterior horn lateral meniscal oblique radial tear (LMORT) has emerged to characterize the tear patterns of the lateral meniscus in many patients with acute anterior cruciate ligament (ACL) injury. There is a lack of data regarding the exact incidence according to the types of LMORT and clinical outcomes. Purposes: (1) To investigate the incidence of LMORT according to type in patients with acute ACL reconstruction (ACLR) and (2) to identify healing status after repair of LMORT via second-look arthroscopy and clinical outcomes. Study Design: Case series; Level of evidence: 4. Methods: Patients who underwent primary ACLR within 6 months of injury were retrospectively reviewed. The LMORT was classified into 4 types based on the severity and distance from the root: type 1 (partial tear <10 mm from the root), type 2 (complete tear <10 mm from the root), type 3 (partial tear >10 mm from the root), type 4a (complete tear >10 mm from the root), and type 4b (type 4a with longitudinal tear at the meniscocapsular junction). Only patients with LMORT were isolated, and the clinical outcomes were compared according to the healing status of LMORT in second-look arthroscopy. Results: Of 635 patients with ACLR, LMORT was identified in 97 patients (15.3%), and type 4 LMORT accounted for the largest proportion (n = 62; 32.6%) of 190 lateral meniscal tears. In 79 patients with LMORT who satisfied the 2-year follow-up period, all patient-reported outcomes (PROs), including the Lysholm (preoperative, 64.1; postoperative, 88.2) and International Knee Documentation Committee subjective (preoperative, 50.5; postoperative, 82.9) scores, were significantly improved (P < .001) 31.8 months postoperatively. Of the 61 patients who underwent second-look arthroscopy, 49 (80.3%) were classified into the complete healing group. There was no significant difference in postoperative PROs between the complete and partial healing groups. Conclusion: The incidence of LMORT was 15.3% in patients with acute ACL injury, and type 4 LMORT was the most common type. Complete healing of LMORT was achieved in 80.3% of patients who underwent second-look arthroscopy, and the PROs were significantly improved postoperatively. Good clinical results can be achieved if the LMORT is repaired as much as possible during ACLR.

Increasing incidence of anterior cruciate ligament reconstruction: a 17-year population-based study.

Anterior cruciate ligament (ACL) injuries are one of the most frequently studied injuries in orthopedic care and research. However, limited epidemiological data are available in Canada regarding trend and distribution of anterior cruciate ligament reconstruction (ACLR). In this paper, our purpose was to assess trends of ACLR between 2002/03 and 2018/19 by age, sex, season of surgery, and location (inpatient vs outpatient) of surgery. In this descriptive epidemiological study of retrospective data available from Alberta Ministry of Health, we report annual incidence of ACLR between 2002/03 until 2018/19 among Albertans aged 10years and older. Information was collected by authors from physician claims database for primary ACLR and revision ACLR and linked with other databases. Incidence proportions (number of ACLR/100,000 population) were calculated and compared by age category and gender over the study period. A total of 28,401 primary ACLR and 2085 revision ACLR were identified during the study period. Age-standardized annual incidence of primary ACLR increased from 40.6 to 51.2 per 100,000 population aged 10years and older. Average annual increase in ACLR incidence was higher among females (1.8% per years) compared to males (0.96% per year). The overall peak incidence and peak incidence among males was observed in 20-29year age group, whereas peak incidence in females was observed in 10-19years of age. The number of ACLR in females outnumbers those among males for 10-19year age group. Generally, a lower proportion of ACLR were conducted in summer compared to other seasons. Primary ACLR conducted in outpatient setting increased from 72% in 2002/03 to 97% in 2018/19. The incidence of ACLR is increasing in Alberta, especially among females and among younger cohorts under 20years of age. This information can help clinicians to provide patient education and policy-makers to design and implement targeted ACL injury prevention programs. Level III.

Epidemiology and Revision Rates of Pediatric ACL Reconstruction in New York State

Background: There are limited epidemiologic data examining the incidence of pediatric anterior cruciate ligament reconstruction (ACLR) over the past decade. Purpose: To examine statewide population trends in the incidence of ACLR in a pediatric population. Study Design: Descriptive epidemiology study. Methods: Inpatient and outpatient claims for pediatric patients who underwent ACLR between 2009 and 2017 were identified in the New York Statewide Planning and Research Cooperative System database via International Classification of Diseases (ICD), Revision 9, Clinical Modification; ICD, Revision 10, Clinical Modification and Procedural Classification System; or Current Procedural Terminology codes. New York population data for each year between 2009 and 2017 were used from the New York State Department of Health to calculate the rates of ACLR per 100,000 people aged 3 to 19 years and determine the 95% confidence limits. The rates were then stratified by age, sex, and insurance. Two-year rates of revision and contralateral ACLR were also analyzed by sex. Results: Between 2009 and 2017, 20,170 pediatric ACLRs were identified. The rates of pediatric ACLR increased steadily from 49.3 per 100,000 in 2009 (95% CI, 47.2-51.4) to a peak of 61.0 (95% CI, 58.6-63.4) in 2014 and decreased to 51.8 (95% CI, 49.6-54.1) by 2017. The age group 15 to 17 years had the highest rates of ACLR of all age groups, peaking at 198.5 (95% CI, 188.3-208.7) per 100,000. Analysis by sex showed that ACLR rates between males and females were not different. Males had a 2-year ipsilateral revision rate of 4.3%, while females had a rate of 3.3% (P = .0001). Females had a contralateral ACLR rate of 4.0%, while males had a rate of 2.6% (P = .0002). Conclusion: Pediatric ACLR rates continued to rise until 2014, but there was a demonstrable decrease in rates after 2014. This decline in pediatric ACLR may point to the efficacy of injury prevention programs or changes in practice management. The high revision rate in males and high contralateral surgery rate in females can help guide patient counseling for return to play and complication risk. Clinical Relevance: This study showed that ACLR in pediatric patients may be decreasing in recent years. There were differences in revision and contralateral ACLR by sex.

COMPLICATION ANALYSIS OF PEDIATRIC AND ADOLESCENT ACL RECONSTRUCTIONS IN THE ABOS DATABASE

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed in adolescents. Similarly, the rate of ACL reconstructions performed in pediatric patients has been increasing, and this population has the highest rate of primary and revision ACL Surgery. The purpose of this study was to review data on ACL reconstructions performed in patients under the age of 19 years that were submitted to the American Board of Orthopaedic Surgeons (ABOS) Part 2 examination to evaluate post-operative complications and trends over time in applicant fellowship training. METHODS: A query to the ABOS SCRIBE database was submitted for all ACL reconstructions performed in patients less than 19 years old. The database query was based on ICD-9 and ICD-10 diagnostic codes submitted by each applicant. Data included geographic region, fellowship training of the applicant, exam subspecialty, and reported complications. A subgroup analysis of complications was also performed in patients less than 15 years compared to those 15-18 and amongst different applicants based on fellowship training. RESULTS: From 2000 – 2016, 9,767 ACL reconstructions were performed by candidates taking Part 2 of the ABOS board certification process. The mean age at surgery was 16 years (reported age range 0-18) and a meniscus procedure was performed in 57% of cases. There was a 41% increase in ACL reconstructions in those under the age of 15 years between 2000 and 2016. In each age group, the incidence of ACL reconstruction in males was higher than in females (ratio 5:4) except in those 12 and 13 years old whereby the incidence was higher in females (ratio 2:1). A majority (70.5%) of ACL reconstructions were performed by candidates with a sports medicine fellowship. In patients less than 15 years old 24.5% of reconstructions were performed by candidates with a pediatric or dual pediatric and sports medicine fellowship training. The overall complication rate was 13.6% with 0.4% anesthetic related complication (0.2% related to regional anesthesia). The reoperation rate was 0.8% and the readmission rate was 0.5%. Twelve patients (0.14%) sustained a venous thromboembolic event (6 deep vein thrombosis and 6 pulmonary embolism). A majority of complications (10.83%) were related to the surgery. The most common surgery related complications were infection (1.51%) and arthrofibrosis (1.3%). The overall incidence of reported complications was not statistically different between those with sports (13.7%), pediatric (16.3%), or both sports and pediatric fellowships (17.5%). Differences in specific complications were noted when comparing those with only pediatric training and those with only sports medicine fellowship training including graft related problems (1.9% vs. 0.7%, p=0.001, respectively) and nerve palsy/injury (1.9% vs. 0.6%, p&lt;0.001, respectively). CONCLUSION/DISCUSSION: ACL reconstruction in the adolescent and pediatric age groups are primarily performed by candidates with a sports medicine fellowship. Complications rates between candidates reporting either sports medicine or pediatric fellowship training are overall comparable. Graft related complication and nerve palsy/injury were lower in those with sports medicine fellowships and both pediatric and sports medicine fellowships suggesting that additional training in sports medicine or arthroscopy may help minimize those complications. Longitudinal studies evaluating long term risks and complications after pediatric/adolescent ACL reconstruction are needed.

Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002-2014.

Background:Few population-based descriptive studies on the incidence of anterior cruciate ligament (ACL) reconstruction and concomitant pathology exist.Hypothesis:Incidence of ACL reconstruction has increased from 2002 to 2014.Study Design:Descriptive clinical epidemiology study.Level of Evidence:Level 3.Methods:The Truven Health Analytics MarketScan Commercial Claims and Encounters database, which contains insurance enrollment and health care utilization data for approximately 158 million privately insured individuals younger than 65 years, was used to obtain records of ACL reconstructions performed between 2002 and 2014 and any concomitant pathology using Current Procedures Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) codes. The denominator population was defined as the total number of person-years (PYs) for all individuals in the database. Annual rates were computed overall and stratified by age, sex, and concomitant procedure.Results:There were 283,810 ACL reconstructions and 385,384,623 PYs from 2002 to 2014. The overall rate of ACL reconstruction increased 22%, from 61.4 per 100,000 PYs in 2002 to 74.6 per 100,000 PYs in 2014. Rates of isolated ACL reconstruction were relatively stable over the study period. However, among children and adolescents, rates of both isolated ACL reconstruction and ACL reconstruction with concomitant meniscal surgery increased substantially. Adolescents aged 13 to 17 years had the highest absolute rates of ACL reconstruction, and their rates increased dramatically over the 13-year study period (isolated, +37%; ACL + meniscal repair, +107%; ACL + meniscectomy, +63%). Rates of isolated ACL reconstruction were similar for males and females (26.1 vs 25.6 per 100,000 PYs, respectively, in 2014), but males had higher rates of ACL reconstruction with concomitant meniscal surgery than females.Conclusion:Incidence rates of isolated ACL reconstruction and rates of concomitant meniscal surgery have increased, particularly among children and adolescents.Clinical Relevance:A renewed focus on adoption of injury prevention programs is needed to mitigate these trends. In addition, more research is needed on long-term patient outcomes and postoperative health care utilization after ACL reconstruction, with a focus on understanding the sex-based disparity in concomitant meniscal surgery.

Fatigue Behavior of Nitinol Anterior Cruciate Ligament Graft and Inappropriate Femoral Tunnel Placement: Single-Stage Revision Anterior Cruciate Ligament Reconstruction Surgery

Anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee, and progressive instability and disability may develop in a significant number of patients. The incidence of ACL reconstruction is rapidly increasing, as is the number of failures. Although ACL reconstruction is a common procedure, less than satisfactory outcomes have been reported to occur in up to 25% of patients. The reasons for clinical failure after ACL reconstruction are numerous but can be broadly separated into 3 categories: technical, biological, and mechanical failures. It is generally thought that poor tunnel positioning (especially the femoral tunnel) is the most common technical error. Revision ACL reconstruction can be performed in 1 or 2 stages. The decision to perform a multistage approach is based on the position and size of the original tunnels. The varied success rates and associated advantages and disadvantages of each method have resulted in controversy as to the best treatment for revision ACL surgery. We describe our preferred operative technique to remove a fractured nitinol synthetic ACL graft and manage single-stage revision ACL reconstruction without bone grafting.

EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN BRAZIL'S PUBLIC HEALTH SYSTEM

ABSTRACT Introduction: Several studies have reported on the epidemiology of Anterior Cruciate Ligament Reconstruction (ACLR) in Europe and North America; however, there is currently no data relating to Brazil. Objective: To describe the incidence of ACLR in Brazil and investigate temporal trends and differences between age and sex groups. Methods: All reported ACLR cases in the public hospital system between January 2008 and December 2014 were extracted from the Information Technology Department of the Brazilian Ministry of Health. Linear regression analysis was used to assess changes in ACLR incidence in the overall population and among sex and age groups, hospitalization time, and health care costs. Results: A total of 48,241 ACLR were reported from 2008-2014 with an overall incidence of 3.49 per 100,000 persons/year. Males accounted for 82% of the procedures. The incidence of ACLR increased by 56% among males (p=0.01) and by 112% among females (p=0.001). The mean hospitalization time decreased from 2.4 days in 2008 to 1.8 day in 2014 (R2 = 0.883, p= 0.002). The total cost across all years was US$56 million, with a mean of US$1,145 per ACLR. Conclusion: Although the total incidence of ACLR in Brazil is lower compared to other countries, it has increased over the years, especially in females. The creation of an ACLR registry is necessary in the future, for more accurate control and new investigations.

Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix

Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.

Incidence and Trends of Anterior Cruciate Ligament Reconstruction in the United States

Background: Anterior cruciate ligament (ACL) injury is among the most commonly studied injuries in orthopaedics. The previously reported incidence of ACL injury in the United States has varied considerably and is often based on expert opinion or single insurance databases. Purpose: To determine the incidence of ACL reconstruction (ACLR) in the United States; to identify changes in this incidence between 1994 and 2006; to identify changes in the demographics of ACLR over the same time period with respect to location (inpatient vs outpatient), sex, and age; and to determine the most frequent concomitant procedures performed at the time of ACLR. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes 844.2 and 717.83 were used to search the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) for the diagnosis of ACL tear, and the procedure code 81.45 was used to search for ACLR. The incidence of ACLR in 1994 and 2006 was determined by use of US Census Data, and the results were then stratified based on patient age, sex, facility, concomitant diagnoses, and concomitant procedures. Results: The incidence of ACLR in the United States rose from 86,687 (95% CI, 51,844-121,530; 32.9 per 100,000 person-years) in 1994 to 129,836 (95% CI, 94,993-164,679; 43.5 per 100,000 person-years) in 2006 (P = .015). The number of ACLRs increased in patients younger than 20 years and those who were 40 years or older over this 12-year period. The incidence of ACLR in females significantly increased from 10.36 to 18.06 per 100,000 person-years between 1994 and 2006 (P = .0003), while that in males rose at a slower rate, with an incidence of 22.58 per 100,000 person-years in 1994 and 25.42 per 100,000 person-years in 2006. In 2006, 95% of ACLRs were performed in an outpatient setting, while in 1994 only 43% of ACLRs were performed in an outpatient setting. The most common concomitant procedures were partial meniscectomy and chondroplasty. Conclusion: The incidence of ACLR increased between 1994 and 2006, particularly in females as well as those younger than 20 years and those 40 years or older. Research efforts as well as cost-saving measures may be best served by targeting prevention and outcomes measures in these groups. Surgeons should be aware that concomitant injury is common.

The Incidence and Etiology of Anterior Cruciate Ligament Injuries in Patients under the Age of 18 in the State of Wisconsin

Background: ACL injuries can have long-term effects on the musculoskeletal system, causing early osteoarthritis, and are of particular concern in children and adolescents as competitive sports participation increases. Purpose: The objective of this paper was to determine the incidence and characteristics of Anterior Cruciate Ligament (ACL) reconstructions in children in the state of Wisconsin. Methods: Wisconsin Hospital Association inpatient and ambulatory surgery data from January 2006 through December 2010 was used to identify the number of ACL reconstructions performed in pediatric patients younger than 18 years of age in the State of Wisconsin. Incidence rates were computed using US Census Bureau Population Estimates. A retrospective chart review was performed on pediatric patients younger than 18 years of age who underwent an ACL reconstruction at a single tertiary care pediatric center to abstract injury causation information. Results: Between 2006 and 2010, 4059 ACL reconstructions occurred in pediatric patients younger than 18 years of age in Wisconsin. The incidence of ACL reconstructions averaged 56.7 per 100,000 children per year. The mean age over the five years of the study was 15.4-15.9 for both males and females. ACL reconstructions increased significantly by an average of 6% each year, with females 40% more likely than males to have had a reconstruction, and older children significantly more likely to have reconstruction than children 0-11 years old (12-13 years incidence rate ratio=20.1; 14-17 years incidence rate ratio=123.0). Among the chart reviewed cases, sixty-eight percent of ACL tears occurred during organized sporting activities and 68% were caused by a non-contact injury. Conclusion: ACL tears increased significantly in Wisconsin children from 2006 to 2010. Interventions to prevent ACL injuries in children need to be developed and tested and better tracking of injuries is needed to increase understanding of risk.