Trends and Demographics in Anterior Cruciate Ligament Reconstruction in the United States

Abstract

The purpose of this study was to identify the trends and demographics of patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction in the United States. Patients who underwent arthroscopic ACL reconstruction between 2004 and 2009 were identified by searching Current Procedural Terminology codes in the PearlDiver Patient Record Database (PearlDiver Technologies, Fort Wayne, IN). The year of procedure, age, gender, and region of the United States were recorded for each patient. Associated meniscal procedures and the absence or presence of a femoral nerve block were also recorded. The incidence of ACL reconstruction significantly increased over the study period, from 40.9 cases per 10,000 patients in 2004 to 47.8 in 2009 (p < 0.001). Of these cases, 92.8% were associated with either meniscectomy or meniscal repair. ACL reconstruction was performed most commonly in patients aged 10 to 29 years (p < 0.001). A significant male predominance was observed with an incidence ratio of male-to-female of 2.03 (p < 0.001). The frequency of females undergoing ACL reconstruction as a proportion of the total number of annual cases increased from 2,295 in 2004 to 3,476 in 2009 (p = 0.0031). A significant increase in the annual proportion of ACL reconstruction performed under femoral nerve block was also observed, from 2.0% in 2004 to 8.3% in 2009 (p < 0.001). The greatest incidence of ACL reconstruction occurred in the Western region of the United States. An increase in the rate of arthroscopic ACL reconstruction was observed between 2004 and 2009 and 92.8% of the ACL reconstructions were associated with a meniscal procedure. The majority of cases were performed in patients aged 10 to 29 years, with a male predominance. Increases were observed in the number of female cases and proportion performed under a femoral nerve block. The Western region of the United States was found to have a higher incidence of ACL reconstruction.

Keywords

ACL reconstruction - incidence - demographics - trends

• References

• 1 Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 2009; 91 (10) 2321-2328
• 2 Lind M, Menhert F, Pedersen AB. The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2009; 17 (2) 117-124
• 3 Magnussen RA, Granan L-P, Dunn WR , et al. Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway. Knee Surg Sports Traumatol Arthrosc 2010; 18 (1) 98-105
• 4 Ahldén M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J. The Swedish National Anterior Cruciate Ligament Register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. Am J Sports Med 2012; 40 (10) 2230-2235
• 5 Csintalan RP, Inacio MCS, Funahashi TT. Incidence rate of anterior cruciate ligament reconstructions. Perm J 2008; 12 (3) 17-21
• 6 Daffner SD, Beimesch CF, Wang JC. Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine 2010; 35 (11) 1165-1169
• 7 Zhang AL, Montgomery SR, Ngo SS, Hame SL, Wang JC, Gamradt SC. Analysis of rotator cuff repair trends in a large private insurance population. Arthroscopy 2013; 29 (4) 623-629
• 8 Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93 (11) 994-1000
• 9 Collins JE, Katz JN, Donnell-Fink LA, Martin SD, Losina E. Cumulative incidence of ACL reconstruction after ACL injury in adults: role of age, sex, and race. Am J Sports Med 2013; 41 (3) 544-549
• 10 Nordenvall R, Bahmanyar S, Adami J, Stenros C, Wredmark T, Felländer-Tsai L. A population-based nationwide study of cruciate ligament injury in Sweden, 2001-2009: incidence, treatment, and sex differences. Am J Sports Med 2012; 40 (8) 1808-1813
• 11 Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Arøen A. Effect of meniscal and focal cartilage lesions on patient-reported outcome after anterior cruciate ligament reconstruction: a nationwide cohort study from Norway and Sweden of 8476 patients with 2-year follow-up. Am J Sports Med 2013; 41 (3) 535-543
• 12 Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 1995; 23 (6) 694-701
• 13 Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007; 23 (12) 1320-1325.e6
• 14 Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg 2013; 21 (1) 41-50
• 15 Mall NA, Wright RW. Femoral nerve block use in anterior cruciate ligament reconstruction surgery. Arthroscopy 2010; 26 (3) 404-416
• 16 Musahl V, Jordan SS, Colvin AC, Tranovich MJ, Irrgang JJ, Harner CD. Practice patterns for combined anterior cruciate ligament and meniscal surgery in the United States. Am J Sports Med 2010; 38 (5) 918-923