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Abstract

Objectives: To investigate the incidence and demographic features of anterior cruciate ligament (ACL) reconstructions in Australia by age and sex, and to determine whether the incidence has changed during the past 15 years. Design and setting: Descriptive epidemiological analysis of longitudinal data on ACL reconstructions (July 2000 - June 2015) in the National Hospital Morbidity Database. Main outcome measures: Population ACL reconstruction rates, by age group and sex. Results: 197 557 primary ACL reconstructions were performed during the study period; the annual incidence increased by 43% (from 54.0 to 77.4 per 100 000 population), and by 74% among those under 25 years of age (from 52.6 to 91.4 per 100 000 population). In males, the peak incidence in 2014-15 was for 20-24-year-olds (283 per 100 000 population); for females, it was for 15-19-year-olds (164 per 100 000 population). Annual growth in incidence was greatest in the 5-14-year-old age group (boys, 7.7%; girls, 8.8%). Direct hospital costs of ACL reconstruction surgery in 2014-15 were estimated to be $142 million. The annual incidence of revision ACL reconstructions increased from 2.49 (2000-01) to 5.65 per 100 000 population (2014-15), or by 5.6% per year; revisions as a proportion of all ACL reconstruction increased from 4.4% to 6.8%. Conclusions: The increasing incidence of ACL reconstructions in young Australians over 15 years is worrying. The individuals at greatest risk are men aged 20-24 years and women aged 15-19 years; the rate of reconstruction is increasing most rapidly among those aged 5-14 years. Revision rates are increasing more rapidly than those of primary reconstructions.
Increasing rates of anterior cruciate ligament
reconstruction in young Australians, 2000e2015
David Zbrojkiewicz
1,2
, Christopher Vertullo
1,3
, Jane E Grayson
4
The known Rupture of the anterior cruciate ligament (ACL) is
a common and devastating injury that is largely preventable by
neuromuscular agility training.
The new The incidence of ACL reconstructions in Australia is
the highest in the world, and is increasing. At greatest risk are
men aged 20e24 years and women aged 15e19 years, but
incidence is increasing most rapidly among 5e14-year-old
children. The incidence of revision ACL is increasing more
rapidly than that of primary ACL reconstructions.
The implications These ndings justify establishing a national
ACL injury prevention program and an ACL reconstruction
registry to improve outcomes for active young Australians.
Rupture of the anterior cruciate ligament (ACL) is a com-
mon and debilitating injury that typically results from a
non-contact event in which a previously healthy indi-
vidual changes direction at speed while playing a multi-
directional sport. ACL ruptures were once thought to be
uncommon in the skeletally immature,
1
but recent evidence
suggests that the global burden of ACL injury falls increasingly
on adolescents and young adults.
2,3
The short term consequences
of ACL rupture include the inability to participate in sport,
reconstructive surgery, and prolonged rehabilitation.
4
In the long
term, regardless of whether or not an ACL reconstruction is
performed, almost all individuals who tear an ACL are at
increased risk of osteoarthritis and disability,
4-6
and this risk is
substantially increased by concurrent meniscal injury.
4
Descriptive analyses of population-based data indicate that the
incidence of ACL reconstruction in Australia is among the highest
in the world.
2,7
Recent analyses of data in Victorian injury data-
bases have found increasing rates of sport-related hospitalisations
and lower limb injuries in older children and young adults,
3,8
but it
is uncertain whether this trend applies to the entire country, is
conned to younger people, or is sex-specic.
Several studies have found that neuromuscular agility and pro-
prioceptive training programs are effective as preventive measures,
averting 50e80% of ACL injuries.
9-11
Sports injuries, particularly
ACL injuries, are emerging as an internationally recognised public
health problem, making it vital that the demographic features
associated with an increased risk of ACL injury are characterised.
The aim of our study was to investigate the incidence and
demographic features of ACL reconstructions in Australia, by
age and sex, and to determine whether the incidence of ACL
reconstructions has changed during the past 15 years.
Methods
Study design
Longitudinal data for ACL reconstructions were extracted from the
National Hospital Morbidity Database (NHMD) of the Australian
Institute of Health and Welfare (AIHW) (http://www.aihw.gov.
au/hospitals-data/procedures-data-cubes). The NHMD com-
prises condential electronic record summaries for episodes of care
provided by state and territory health authorities, including data
from public and private hospitals, as well as from private surgical
centres. The database affords national coverage of information on
inpatient hospital treatments, with a negligible proportion of
missing data (0.004% of cases per year).
12
The database collects
information on the type of procedure (according to the Interna-
tional Statistical Classication of Diseases and Related Health
Problems, 10th revision, Australian modication [ICD-10-AM]
13
and the third to eighth editions of the Australian Classication of
Health Interventions [ACHI]
14
), year of procedure, sex and age
group of patient, and whether the procedure required day or
overnight admission.
Patients who underwent a primary knee reconstruction during the
period 1 July 2000 e30 June 2015 were identied by ICD-10-AM
block number 1522 (with ICD-10-AM procedure codes 49539-00,
49539-01, 49542-00, 49542-01). AIHW procedure numbers included
both isolated cruciate reconstruction and cruciate reconstruction
with concurrent meniscal injury. Revision knee reconstructions
Abstract
Objectives: To investigate the incidence and demographic
features of anterior cruciate ligament (ACL) reconstructions in
Australia by age and sex, and to determine whether the
incidence has changed during the past 15 years.
Design and setting: Descriptive epidemiological analysis of
longitudinal data on ACL reconstructions (July 2000 eJune
2015) in the National Hospital Morbidity Database.
Main outcome measures: Population ACL reconstruction rates,
by age group and sex.
Results: 197 557 primary ACL reconstructions were performed
during the study period; the annual incidence increased by
43% (from 54.0 to 77.4 per 100 000 population), and by
74% among those under 25 years of age (from 52.6 to 91.4 per
100 000 population). In males, the peak incidence in 2014e15
was for 20e24-year-olds (283 per 100 000 population); for
females, it was for 15e19-year-olds (164 per 100 000 population).
Annual growth in incidence was greatest in the 5e14-year-old age
group (boys, 7.7%; girls, 8.8%). Direct hospital costs of ACL
reconstruction surgery in 2014e15 were estimated to be
$142 million. The annual incidence of revision ACL reconstructions
increased from 2.49 (2000e01) to 5.65 per 100 000 population
(2014e15), or by 5.6% per year; revisions as a proportion of
all ACL reconstruction increased from 4.4% to 6.8%.
Conclusions: The increasing incidence of ACL reconstructions in
young Australians over 15 years is worrying. The individuals at
greatest risk are men aged 20e24 years and women aged
15e19 years; the rate of reconstruction is increasing most rapidly
among those aged 5e14 years. Revision rates are increasing
more rapidly than those of primary reconstructions.
1
Knee Research Australia, Gold Coast, QLD.
2
Grifth University, Gold Coast, QLD.
3
Gold Coast Orthopaedic Research and Education Alliance, Grifth University, Gold Coast, QLD.
4
University of Sydney, Sydney, NSW. d.zbrojkiewicz@grifth.edu.au jdoi: 10.5694/mja17.00974 jSee Editorial, p. 341 jPublished online 23/04/2018
Podcast with Christopher Vertullo available at https://www.mja.com.au/podcasts
Research
MJA 208 (8) j7 May 2018
354
were identied by ICD-10-AM block number 1524 with the ICD
procedure code 49551-00.
ACL incidence rates were expressed as number per 100 000 pop-
ulation for each year of the study, based on Australian Bureau of
Statistics population gures.
15
Statistical analysis
Trends in population-adjusted numbers of procedures were ana-
lysed in SPSS Statistics 23 (IBM). P< 0.05 was deemed statistically
signicant.
Ethics approval
The base data for this investigation were de-identied data
publicly available from the AIHW. Our investigation was
therefore granted exemption from formal ethics review by the
Grifth University Human Research Ethics Committee.
Results
During 2000e2015, 197 557 primary ACL reconstructions were
performed in Australia: 134 695 (68.2%) in males and 62 862
(31.8%) in females. The annual number of primary ACL re-
constructions increased from 9662 in 2000e01 to 16 990 in 2014e15;
the overall incidence of ACL reconstructions increased by
43% during this period, from 54.0 to 77.4 per 100 000 population.
The rate in males increased from 73.3 to 101.6 per 100 000, in fe-
males from 35.0 to 53.4 per 100 000 population (average annual
growth rates of 2.2% and 2.9% respectively) (Box 1).
Throughout the study period, the rates were higher for males than
for females in all 5-year age groups. In males, the peak incidence in
2014e15 was for the 20e24-year-old group (283 per 100 000 pop-
ulation), but rates were also high for 15e19-year-olds (241 per
100 000) and 25e29-year-olds (232 per 100 000). In females, the
peak incidence was for the 15e19-year-old group (164 per 100 000
population) (Box 2,Box 3).
Annual growth in the incidence of ACL reconstruction was highest
for the 5e14-year-old age group (7.7% for males, 8.8% for females);
the rates for 15e19-year-olds were 4.4% (males) and 5.0% per year
(females). The growth rates were also large for older age groups:
5.3% (males) and 4.2% annually (females) for people aged 45e49
years, and 6.0% (males) and 4.8% per year (females) for those aged
50e54 years (Box 4).
During the 15-year period analysed, the annual incidence of ACL
reconstruction in people under 25 years of age grew by a total of
73.8% (3.8% per year); the incidence for those aged 25 or more
increased by 28.4% (1.7% per year) (Box 5). The incidence in females
under 25 grew by a total of 90.6% (4.4% per year), in males under 25
by 69.3% (3.7% per year) (Box 6). Incidence rates for 2015e16 to
2024e25 were forecast by assuming that trends over the past 15
years will be maintained. On this basis, overall growth in incidence
for the period 2000e01 to 2024e25 will be greatest for females
under 25 (239%, or 8.5% per year); the projected total growth for
males under 25 is 119% (5.4% per year), and for all people over 25 it
is 48.7% (2.7% per year) (Box 6).
Estimated costs of anterior cruciate ligament surgery
According to the 2017 variance report of the Royal Australasian
College of Surgeons and Medibank, the average direct hospital and
surgery cost per ACL reconstruction was $8364.
16
The estimated
direct costs of primary ACL reconstruction surgery in 2014e15
were $142 million. This gure does not include the rehabilitation,
disease burden, and societal costs associated with the injury.
1 Incidence of primary anterior cruciate ligament
reconstruction in Australia, 2000e2015, by sex
2 Incidence of primary anterior cruciate ligament
reconstruction in males, 2000e2015, by age group
3 Incidence of primary anterior cruciate ligament
reconstruction in females, 2000e2015, by age group
Research
MJA 208 (8) j7 May 2018
355
Revision anterior cruciate ligament surgery
A total of 12 878 revision ACL reconstructions were reported
during 2000e01 to 2014e15; 9588 (74.5%) were for males and 3290
(25.5%) for females. The annual number increased from 477 in
2000e01 and to 1328 in 2014e15; the annual incidence increased by
127%, from 2.49 to 5.65 per 100 000 population, or by 5.6% per year.
The incidence in males increased from 3.62 to 8.35 per 100 000
population (5.7% per year), in females from 1.37 to 2.98 per 100 000
population (5.3% per year) (Box 7). Revision ACL reconstructions
as a proportion of all reconstructions increased from 4.4% in
2000e01 to 6.8% in 2014e15.
Discussion
During 2000e2015, the incidence of ACL reconstruction surgery
increased in Australia in all age groups; the overall incidence was
greatest among 15e24-year-olds. Consistent with other recent
reports,
1,3,17
the rate of growth in incidence was greatest among
5e14-year-old children.
Our calculated primary ACL reconstruction incidence of
77.4 per 100 000 population is the highest population-
adjusted rate in the world; lower rates in comparable
Organisation for Economic Cooperation and Develop-
ment (OECD) nations include those for the United States
(52), New Zealand (37), Denmark (38), Norway (34), and
Sweden (32 per 100 000 population).
7
We identied age and sex differences in the incidence of
ACL reconstruction surgery, with the peak incidence in
males being for a slightly older age group and
73% higher than the peak incidence in females. This is
consistent with studies that have reported higher rates
of ACL reconstruction in males,
2,18,19
despite females
being two to ten times more likely to rupture their ACL
when participating in high risk sports such as basketball
and soccer.
20,21
It is conceivable that the higher incidence
in males reects greater participation in sports such as
Australian rules football, in which pivoting, jumping
and rapid deceleration increase the risk of ACL injury.
22
That the peak incidence for females is in a younger age
group is consistent with their higher rates of sports
participation during early adolescence, declining when they reach
18e24 years.
23
ACL rupture imposes a considerable health burden on a young and
active population. We identied an annual incidence growth in its
incidence for Australians under 25 of 3.8%, compared with 1.7% for
those over 25. Moreover, growth in reconstruction incidence was
most rapid for boys (7.7%) and girls (8.8%) aged 5e14 years,
although it should be noted that the base ACL reconstruction
incidence in this age group was low. The increased incidence in
children is nevertheless of particular concern, as ACL injury in this
age group was previously rare. The burden of future degenerative
disease falls most heavily on our youngest patients.
24
The rising incidence of ACL reconstruction during 2000e2015 can
be attributed to several factors, including increasing medical and
public awareness of the procedure, diagnostic improvements, the
availability of magnetic resonance imaging, and increased access to
orthopaedic surgeons.
3,25,26
About 72% of ACL reconstructions in
Australia are sport-related; the sports most frequently involved are
Australian rules football, rugby union, rugby league, netball,
basketball, soccer, and skiing.
2,4
The rise of ACL injury in young
people has been attributed to earlier specialisation by younger
5 Incidence of primary anterior cruciate ligament
reconstruction in Australia, 2000e2015, by
broad age group
4 Annual growth in the incidence of primary anterior
cruciate ligament reconstruction, 2000e2015, by sex and
age group
6 Incidence of primary anterior cruciate ligament reconstruction in
Australia, 2000e2015, by sex and broad age group
Research
MJA 208 (8) j7 May 2018
356
athletes, longer sporting seasons, more intense training, higher
levels of competition,
1
and a lack of free play.
25-27
The costs of ACL injury can be divided into direct and indirect
costs. We estimated the direct hospital costs for ACL re-
constructions were $142 million in 2014e15, a substantial cost to
the health care system that is growing with the incidence of ACL
injuries. Despite the considerable direct hospital costs, ACL
reconstruction surgery is signicantly more cost-effective than
rehabilitation alone in both the short and long term, with patients
experiencing greater improvements in quality-adjusted life-years
at a lower cost.
28
An American group calculated the average life-
time costs to society per ACL rupture to be $US88 938 with reha-
bilitation only and $US38 121 with ACL reconstruction.
28
In young
people, delaying ACL reconstruction surgery or opting for non-
operative management is associated with signicantly poorer
outcomes in both the short and long terms.
29
Nevertheless, prevention is much more cost-effective than either
ACL reconstruction or rehabilitation. Establishing a national ACL
injury prevention program has been reported as a cost-effective
strategy for improving sporting health outcomes for young Aus-
tralians, with low barriers to implementation.
4
In addition to
reducing health care costs, prevention programs allow athletes to
avoid the consequences of injury, including reduced functional
capacity because of pain, chronic knee instability,
28
and time away
from work or education.
30
In the longer term, the future compli-
cations of osteoarthritis
4
can lead to loss of productivity, fewer
employment opportunities, reduced social interaction, and lower
quality of life.
31
The link between ACL injury and knee replacement later in life is
also important.
5,6
The incidence of knee replacements in Australia
is high compared with other OECD nations, and it is expected to
continue to increase.
32
An estimated annual loss of $9.4 billion in
GDP has been attributed to early retirement caused by arthritis in
Australia.
33
The incidence of revision ACL reconstruction surgery increased
across the study period by an average 5.6% per year, and the
proportion of reconstructions that were revision reconstructions
rose from 4.4% to 6.8%. While graft position, tunnel placement,
younger age, and early return to sport are established risk factors
for ACL graft failure,
34,35
further investigations are warranted, and
the need to carefully document emerging trends, risk factors and
the effects of interventions would justify the establishment of a
national ACL reconstruction registry.
36
As we analysed national electronic records summaries for episodes
of care, our investigation had some limitations. Firstly, AIHW
procedural data cubes did not allow differentiation between ACL
and posterior cruciate ligament (PCL) reconstructions. While iso-
lated PCL injuries requiring reconstruction are uncommon (fewer
than 1% of all knee injuries seen in the clinic),
37
the risk of osteo-
arthritis after PCL reconstruction is similar to that for ACL recon-
struction. Secondly, the AIHW data did now allow analysis of
reconstruction rates by state and territory, limiting our analysis to
the national scale. Additionally, as with any database study, cod-
ing errors are possible. Accurate direct hospital costs per ACL
reconstruction were unavailable for 2014e15, and the estimated
costs for this year were calculated using 2017 costing data. The
validity of comparing ACL reconstruction rates in different coun-
tries is limited by the availability of data on the incidence of ACL
injuries and reconstruction, which are related but distinct phe-
nomena. While the rate of ACL reconstruction may be an indirect
measure of that of ACL injury, many ACL injuries are either not
diagnosed or do not lead to surgical reconstruction.
Conclusion
This Australian population-level data analysis found a worrying
increase in the incidence of ACL reconstructions in young Aus-
tralians during 2000e2015. Most such reconstructions could be
averted by neuromuscular agility training and other preventive
measures. The individuals at greatest risk are men aged 20e24
years and women aged 15e19 years; the rate of reconstruction is
increasing most rapidly among boys and girls aged 5e14 years.
Moreover, rates of revision reconstruction are increasing more
rapidly than the rate of primary ACL reconstructions. The
increasing incidence of ACL injury in Australia is an emerging
public health problem with potentially detrimental long term
health outcomes, especially for young people.
Competing interests: No relevant disclosures.
Received 5 Oct 2017, accepted 12 Dec 2017. n
ª2018 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.
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... Similar to previous work, 17,18 we further investigated the influence of demographics by calculating sex-specific growth rates for the following age groups: 5−14, 15 −24, 25−34, 35−44, and 45+ years. Note that in this analysis, data was occasionally not over dispersed (e.g., articular cartilage tears for 35−44-year-old males); hence, negative binomial regression was not appropriate. ...
... A previous investigation of ACL-reconstruction rates in Australia from 2000 to 2015 showed similar annual growth rates of 8.8% and 7.7% per year, for 5−14 years-old females and males, respectively. 17 An analysis of paediatric ACL injuries in Finland also showed that young females (aged 13 −15 years) showed the largest increase in ACL injury incidence over an 18-year study period, compared to other age/sex groups. 19 Additionally, data from Southern Sweden 20 and the United States 21 showed similar trends in knee injury incidence across the lifespan, whereby knee injury incidence typically increased during childhood, peaked between the ages of 15 −24 years, and gradually declined thereafter. ...
Article
Full-text available
Background Acute knee injuries are a key predisposing risk factor for knee osteoarthritis. Public health interventions require in-depth epidemiological evidence to determine which knee injuries are problematic in critical age and sex demographics. Methods Descriptive epidemiological analysis of longitudinal data on knee injuries (July 1998 – June 2018) from the National Hospital Morbidity Database in Australia were studied. The main outcomes where the population-related knee injury frequency, incidence per 100,000 and annual growth rate (%) over the 20-year observation period. Age-group and sex differences were also studied to determine demographic-specific trends. Findings 228,344 knee injuries were diagnosed over the 20-year analysis period. Significantly rising annual incidences were observed for total knee injuries, anterior cruciate ligament (ACL) injuries and knee contusions in males and females. Posterior cruciate ligament (PCL) injuries and knee dislocations were also rising in females, but not males. Greater annual growth rates were observed for females compared to males for total knee injuries, knee contusions, PCL injuries and knee dislocations. Demographic analysis revealed that the highest annual growth rate in injury incidence (10.4%) was observed for ACL injuries in females aged 5–14 years old. Interpretation Increasing annual incidence of knee injuries was observed over the 20-year period. Males have a higher incidence of knee injury per capita than females, but the gap appears to have narrowed over the 20-year analysis period. Younger Australians show a precipitous rise in the annual number of ACL injuries, particularly for females aged 5–14 years. These trends warrant urgent intervention. Funding None.
... In Australia alone, Page 2 of 13 Giummarra et al. BMC Musculoskeletal Disorders (2022) 23:332 there has been an increasing trend over the recent years to proceed to ACL reconstructions with operations increasing by 43% within the last decade [5]. Anatomically, the ACL consists of two bundles which are named according to their tibial attachment. ...
... There is no current consensus on 'standard care' in the treatment of partial ACL tears, and treatment is often tailored to the individual depending on age, sex, level of sport/activity and other concomitant knee injuries at the time i.e. meniscal tear. Most often, the treatment of partial ACL tears involves surgery [5]; with surgical management of such tears includes bundle sparing, augmentation, or complete reconstructions [11]. Pujol's review showed that patients had good short and medium term functional results when they limit their sporting activities, with 52% of patients retuning to the pre-injury levels of sporting activity after a partial ACL tear [13]. ...
Article
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Background The incidence of anterior cruciate ligament (ACL) injuries represents a large burden of knee injuries in both the general and sporting populations, often requiring surgical intervention. Although there is much research on complete ACL tears including outcomes and indications for surgery, little is known about the short- and long-term outcomes of non-operative, physiotherapy led intervention in partial ACL tears. The primary aim of this study was to evaluate studies looking at the effectiveness of physiotherapy led interventions in improving pain and function in young and middle-aged adults with partial ACL tears. Additionally, the secondary aim was to evaluate the completeness of exercise prescription in randomised trials for physiotherapy led interventions in the management in partial ACL tears. Methods A comprehensive and systematic search was performed on six databases ( Medline, CINAHL, EMBASE, PEDro, Scopus , SPORTDiscus and Cochrane). The search strategy consisted of two main concepts: (i) partial ACL tears, and (ii) non-operative management. 7,587 papers were identified by the search. After screening of eligible articles by two independent reviewers, 2 randomised studies were included for analysis. The same two reviewers assessed the completeness of reporting using the Toigio and Boutellier mechanobiological exercise descriptions and Template for Intervention Description and Replication (TIDieR) checklist. Group mean standard deviations (SD) for the main outcomes was extracted from both papers for analysis. Prospero Registration Number: CRD42020179892. Results The search strategy identified two studies; one looking at Tai Chi and the other Pilates. The analysis indicated that Tai Chi was significant in reducing pain scores and both Tai Chi and Pilates were found to increase Muscle Peak Torque Strength (MPTS) at 180 degrees. Furthermore, Tai Chi showed a significant increase in proprioception. Conclusions Physiotherapy led interventions such as Pilates, and Tai Chi may improve pain, proprioception and strength in young and middle-aged adults with partial ACL tears, however full scale, high-quality randomised studies are required with long term outcomes recorded.
... The incidence of anterior cruciate ligament (ACL) injuries has increased significantly in the pediatric population, with peak incidence during high school years. 1,3,32 Prompt, effective treatment is important given the elevated risk for subsequent cartilage or meniscal injury, as well as persistent instability and earlier-onset osteoarthritis in this young, active age group. 8,16 Compared with adults, children and adolescents are at increased risk for graft failure, which may require revision surgery with worse outcomes as well as substantial financial and psychosocial burdens. ...
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Background Anterolateral ligament reconstruction (ALLR) and lateral extra-articular tenodesis (LET) show promise in lowering the risk of rerupture after anterior cruciate ligament reconstruction (ACLR), but there are little data on surgeon practices and preferences in children and adolescents. Purpose To quantify surgeon practices regarding ALLR and LET in the pediatric population. Study Design Cross-sectional study. Methods An electronic survey was administered to 87 surgeons in the Pediatric Research in Sports Medicine society. The questionnaire asked several questions about surgeon and practice characteristics as well as indications, preferences, and techniques for ALLR or LET in the context of primary and revision pediatric ACLR. Chi-square and Fisher exact tests were used to evaluate factors that affect surgical preferences. Results A total of 63 surgeons completed the survey, of whom 62% performed ≥50 pediatric ACLRs annually; 56% sometimes performed anterolateral augmentation with primary ACLR, and 79% with revision ACLR. The most common indications for ALLR or LET in the primary setting were high-grade pivot shift, knee hyperextension, generalized laxity, and type of sports participation. Surgeons whose practice was >75% sports medicine were more likely to perform ALLR or LET with both primary and revision ACLR ( P = .005 and P < .001, respectively). Those who had completed a sports medicine fellowship were more likely to perform these procedures than those with only pediatric orthopaedic training, in both primary (68% vs 36%; P = .01) and revision scenarios (92% vs 60%; P = .002). Of the 28 respondents who did not perform ALLR or LET with primary ACLR, 75% cited insufficient evidence as the reason. However, 96% of surgeons who did perform these procedures expressed interest in studying them prospectively, and 87% were willing to randomize patients. Conclusion Findings indicated that 56% of pediatric sports surgeons sometimes perform anterolateral augmentation with primary ACLR and 79% with revision ACLR. Surgeons with sports medicine fellowship training or a mostly sports practice were more likely to perform these procedures. Insufficient evidence was the most common reason given by surgeons who did not perform anterolateral augmentation. However, there was substantial willingness to prospectively study and even randomize pediatric patients to assess the impact of ALLR or LET in this population.
... Knee injuries are the most prevalent injuries, accounting for 50% of musculoskeletal injuries. In the United States, roughly 17 million ligamentous injuries necessitate medical care each year, at an estimated cost of over $40 billion [3,4]. In addition to the high financial cost of ligaments replacement, these injuries have a major impact on patients' careers and capacity to accomplish their vocational, recreational, and in some cases permanently impair physical activity. ...
Article
With the increasing uptake of sport activities, onsite detection of associated knee injuries at early stages is in high demand to avoid severe ligament tear and long treatment period. Portable electromagnetic imaging (EMI) systems have the potential to meet that demand, but there are challenges. For example, EMI is based on the contrast in the dielectric properties due to the accumulated fluid after knee injury. However, that fluid can be in any shape and orientation. Therefore, to capture enough data for processing, EMI should operate as a dual-polarized wearable system with compact antennas. Thus, the proposed system is a textile brace worn on the knee and consists of an 8-element dual-polarized aperture antenna array, which is matched with the knee. Each of the utilized antennas is fed by two orthogonal coaxial feed, occupies a small size of 36363.1 mm^3, and is backed by a full ground plane for unidirectional radiation. The antenna covers the band 0.7-3.3 GHz (130 %), with front to back ratio of more than 10 dB. The textile wool-felt is used as the substrate to enable building flexible brace system. The system's capability to reconstruct knee images with different injuries is verified on realistic knee models and phantoms. The double stage delay, multiply and sum algorithm (DS-DMAS) is used to reconstruct those images, which demonstrate efficiency of the dual-polarized system and its superiority over single-polarized systems.
... Despite previous studies identifying LEMSK injury risk factors and implementing biomechanical-focused and neuromuscular-focused interventions, there is inconsistent success in preventing the occurrence of LEMSK injury. [7][8][9] Lack of consistent benefits from injury prevention strategies may be attributed to risk screening and intervention strategies that overlook cognitive and oculomotor risk factors that amplify biomechanical risk factors. 10 Emergent evidence indicates that cognitive and oculomotor deficits may contribute to LEMSK injury, 10 offering further opportunities to better identify at-risk athletes and develop personalized risk-reduction strategies. ...
Article
Objective: Strategies to identify lower extremity musculoskeletal (LEMSK) injury risk have been informed by prospectively identified biomechanical and neuromuscular risk factors. Emergent evidence suggests that cognitive and oculomotor performance may also contribute to LEMSK injury. The purpose of this study was to determine whether prospective cognitive and oculomotor measures identify adolescent athletes who sustain an in-season LEMSK injury. Design: Prospective longitudinal study. Settings: Controlled laboratory and athletic event settings. Participants: Four hundred eighty-eight adolescent male football and female soccer athletes aged 13 to 18 years. Assessment of risk factors: Preseason baseline cognitive and oculomotor performance: Attention Network Task (ANT), cued task switching, King-Devick test, and near point of convergence. Main outcome measure: Incidence of LEMSK sprains and strains during a single competitive season. Results: Attention Network Task-orienting network reaction time (RT) was the only cognitive or oculomotor measure significantly associated with LEMSK injury [B = 1.015, 95% confidence interval (CI): 1.01-1.024, P < 0.01]. Every 10 milliseconds increase in orienting network RT was associated with a 15% increased risk for LEMSK injury. Athletes demonstrating an orienting network RT ≥ 32.8 milliseconds had a higher risk for LEMSK injury relative to athletes below the cut-point (relative risk, 2.62; 95% CI, 1.52-4.52; odds ratio, 3.00; 95% CI, 1.63-5.52). Conclusions: Deficits in visual-spatial components of attention were associated with 2.62 times greater risk for LEMSK injury in adolescent athletes. The present results add evidence to suggest that visual-spatial attentional processing contributes to LEMSK injury and may supplement previously established LEMSK injury risk assessments.
... Despite this evidence, rates of primary and revision ACLR continue to rise in Australia (Zbrojkiewicz et al., 2018) and globally (Sanders et al., 2016). One explanation is that people overestimate the benefits of ACLR. ...
Article
Background Most people who suffer an anterior cruciate ligament (ACL) injury search for information online. Objectives Summarise the proportion of webpages on ACL rupture management that present evidence-based information. Design Content analysis. Methods We examined webpage information on ACL ruptures identified through (1) Google searches using terms synonymous with ‘anterior cruciate ligament rupture’ and searching ‘knee surgeon’ linked to each Australian capital city, and (2) websites of professional associations. The primary outcome was the proportion of webpages that suggest people can return to at least some form of sport with non-surgical management. Secondary outcomes included webpage information on return to sport with ACL reconstruction (ACLR) and non-surgical management, benefits, harms, and risk of osteoarthritis related to these options, and activity modification. Results Out of 115 webpages analysed, 48% suggested people can return to at least some form of sport with non-surgical management. Almost half of webpages suggested most people will return to some form of sport following ACLR (41%) and mentioned benefits of ACLR (43%). Fewer webpages mentioned benefits of non-surgical management (14%), approximately two in three people return to pre-injury level of sport following ACLR (4%), risk of re-injury following ACLR (23%), most people return to sport within 9 months of ACLR (27%), activity modification as a management approach (20%), and ACLR will reduce the risk of osteoarthritis (23%). Conclusion Most online information on ACL rupture management isn't aligned with the best available evidence. Inaccurate information could mislead patients' treatment choices and create unrealistic expectations for return to sport.
Article
Background Achieving pre-injury activity level after an injury is the fundamental goal of any orthopedic treatment for an athlete. Unfortunately, pre-injury activity levels differ significantly in different patient categories, especially in athletes and non-athlete. Hence, an outcome suitable to a non-athlete may not be adequate for an athlete. This has led to variations in the surgical approach to the same injury in an athlete and non-athlete. There is plenty of literature published comparing the outcome in athletes and non-athletes after a particular surgery. Scattered discussion about variations in these surgeries based on functional demand was done in many publications. But there was a lack of a comprehensive narrative review summarizing variations in common operations among athletes and non-athletes. Aim This review attempted to summarize variations in common sports operations between high functional demand patients and low demand patients and discuss the variations from the author's perspective. Methods A review of all the relevant papers were conducted focusing on athletes and non-athletes. Most commonly performed sports surgeries were ACL reconstruction, Meniscal repair, PCL reconstruction, and Shoulder instability surgery. A literature search was done for each commonly performed surgery using relevant keywords in PubMed and Google Scholars. Summary of papers pertinent to athletes and non-athletes were compiled to prepare this narrative review. Results There is a lack of papers directly comparing results in athletes and non-athletes. However, many research papers discussed surgical variations in athletes (high demand) and non-athletes (low demand) patients. There are controversies in all commonly performed surgeries, and none of the papers gives a definitive guideline on the approach to athletes and non-athlete. Conclusion Rather than a common suggestion on surgical variation, an individualized approach would be appropriate to decide on variation in particular surgery in both athletes and non-athletes.
Article
Purpose: To compare return to sport and clinical results in young active patients who underwent anatomic single-bundle (SB) versus double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). Methods: Young active patients undergoing SB or DB ACLR from 2017 to 2019 at our institution were retrospectively reviewed. The primary outcome measures were the rate and time to return to sports, with secondary measures including the Lachman test, pivot shift test, Lysholm scores, International Knee Documentation Committee (IKDC) scores and graft rupture. Results: The study included a total of 90 patients (DB group, 42; SB group, 48), with a mean follow-up of 27.1 ± 6.1 months. Young active patients who underwent DB ACLR had a higher rate of return to pivoting sports than those who underwent SB ACLR (HR = 2.4; 95% confidence interval [CI]: 1.4, 4.1; p = 0.013). The DB group returned to pivoting sports at a mean ± SD of 11.0 ± 2.9 months compared with 12.7 ± 2.7 months in the SB group (p = 0.01). There was one traumatic failure in the SB group and one contralateral ACL rupture in the DB group. There was no significant difference in the rate and time to return to running, Lachman test, pivot-shift test, Lysholm or IKDC scores in either group. Conclusion: Both anatomical SB and DB techniques achieved satisfactory clinical outcomes. DB techniques led to superior performance of return to pivoting sports but nonsignificant differences in time and rate of return to running, passive stability measurement, subjective knee function outcome and graft rupture rate in both groups at the 2-year follow-up. The DB ACLR should be considered a viable option to treat young patients with high activity demands. Level of evidence: III.
Article
Importance Synthetic reinforcement of autografts in anterior cruciate ligament reconstruction offers theoretical benefits in terms of improved graft strength, potentially reducing graft elongation and failure. Over the past three decades, a number of synthetic/autograft combinations have been used in clinical practice. Aim We aimed to assess the impact of synthetic reinforcement on graft rupture rates and functional outcomes following autograft ACL reconstruction. Evidence review A systematic review of Pubmed, Embase and Cochrane libraries was undertaken according to the PRISMA guidelines. Published clinical studies reporting outcomes after autograft ACL reconstruction with synthetic reinforcement, with a minimum of 20 patients and two-year follow-up were included. The MINORS tool was used for methodological assessment. Findings Twenty articles reporting 1,888 patients managed with synthetically reinforced grafts were included in the analysis. The mean MINORS score was 13 (Range, 2 – 22). The synthetic reinforcement used was the Kennedy ligament augmentation device in 8 studies, LARS in 4, Fibertape in 2, Leeds-Keio in 2, and Trevira ligament, Dacron, PDS and Artelon in 1 study each. No study reported a significant reduction in graft failure with reinforcement. Two studies reported superior KT-1000 clinical stability in reinforced grafts. One study reported superior pain, KOOS and IKDC scores and earlier return to activity in reinforced grafts. Conclusions and relevance In this systematic review, synthetic reinforcement of ACL autografts did not result in a reduced rate of graft rupture. A small number of studies have reported superior stability and patient reported outcome measures with modern synthetic reinforcement techniques.
Article
Introduction Anterior cruciate ligament (ACL) rupture in military personnel and civilians can be a devastating injury. A service member is 10 times more likely to suffer an ACL injury than their civilian counterparts, and despite successful surgical stabilization, 4%-35% will develop arthrofibrosis, over 50% will not return to full active duty, and up to 50% will develop post-traumatic osteoarthritis (PTOA) within 15 years. Equally concerning, woman are 2 to 8 times more likely to experience ACL injuries than men, which represents a major knowledge gap. Materials and Methods A comprehensive literature search was performed in December 2021 using structured search terms related to prevalence, risk factors, disease progression, and treatment of ACL injury and reconstruction. The literature search was conducted independently by two researchers using PubMed, Cochrane, and Embase databases, with inclusion of articles with military, civilian, and sex relevance, and exclusion of most papers with a publication date greater than 10 years. The resources used for the review reflect the most current data, knowledge, and recommendations associated with research and clinical findings from reliable international sources. Results Currently, there is no effective system-based drug therapy that creates a “permissive environment” to reduce synovial and cartilage stress after ACL injury and reconstruction and prevent secondary complications. We argue that progress in this area has been hampered by researchers and clinicians failing to recognize that (1) an ACL injury is a system’s failure that affects the whole joint, (2) the early molecular events define and perpetuate different injury phenotypes, (3) male and female responses may be different and have a molecular basis, (4) the female phenotype continues to be under-represented in basic and clinical research, and (5) the variable outcomes may be perpetuated by the trauma of surgery itself. The early molecular events after ACL injury are characterized by an overexpression of joint inflammation, immune dysfunction, and trauma-induced synovial stress. We are developing an upstream adenosine, lidocaine, and magnesium therapy to blunt these early molecular events and expedite healing with less arthrofibrosis and early PTOA complications. Conclusions ACL injuries continue to be a major concern among military personnel and civilians and represent a significant loss in command readiness and quality of life. The lack of predictability in outcomes after ACL repair or reconstruction underscores the need for new joint protection therapies. The male–female disparity requires urgent investigation.
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Anterior cruciate ligament (ACL) injuries in children and adolescents have been the focus of recent media attention and parental concern, given their potential for adverse long-term health outcomes and healthcare costs. However, there is limited formal evidence on trends in the incidence of ACL injuries in children. This study utilizes the Victorian Admitted Episodes Dataset (VAED) to characterize epidemiologic trends of hospital-admitted ACL injuries in those aged 5 to 14 years over a period of 10 years from 2005 to 2015. There was a total of 320 cases and the overall annual rate of ACL injuries increased by 147.8% from 2.74 per 100, 000 population in 2005/2006 to 6.79 per 100, 000 in 2014/2015. The majority (96.9%) of these injuries were in 10-to 14-year-olds. The main in-hospital procedure provided to over 80% of the hospitalized cases involved ACL reconstruction. Sporting activities accounted for 56.6% of ACL injuries. For females, over half (52.4%) of ACL injuries occurred whilst playing ball sports, compared to 35.4% of males. The large increase in ACL injuries in 5-to 14-year-olds in the state of Victoria, Australia over a 10-year period indicates they are a significant and emerging health burden. Population-wide ACL prevention policies are required to halt these trends. Cost effective prevention programs that involve neuromuscular training must be implemented in schools and junior sports teams.
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Background The incidence of joint arthroplasty is increasing worldwide. International estimates of future demand for joint arthroplasty have used models that propose either an exponential future increase, despite obvious system constraints, or static increases, which do not account for past trends. Country-specific projection estimates that address limitations of past projections are necessary. In Australia, a high-income country with the 7th highest incidence of TKA and 15th highest incidence of THA of the Organization for Economic Cooperation and Development (OECD) countries, the volume of TKAs and THAs increased 198% between 1994 and 2014. Questions/purposeTo determine the projected incidence and volume of primary TKAs and THAs from 2014 to 2046 in the Australian population older than 40 years. Methods Australian State and Territory Health Department data were used to identify TKAs and THAs performed between 1994 and 1995 and 2013 and 2014. The Australian Bureau of Statistics was the source of the population estimates for the same periods and population-projected estimates until 2046. The incidence rate (IR), 95% CI, and prediction interval (PI) of TKAs and THAs per 100,000 Australian citizens older than 40 years were calculated. Future IRs were estimated using a logistic model, and volume was calculated from projected IR and population. The logistic growth model assumes the existence of an upper limit of the TKA and THA incidences and a growth rate directly related to this incidence. At the beginning, when the observed incidence is much lower than the asymptote, the increase is exponential, but it decreases as it approaches the upper limit. ResultsA 66% increase in the IR of primary THAs between 2013 and 2046 is projected for Australia (2013: IR = 307 per 100,000, [95% CI, 262-329 per 100,000] compared with 2046: IR= 510 per 100,000, [95% PI, 98-567 per 100,000]), which translates to a 219% increase in the volume during this period. For TKAs the IR is expected to increase by 26% by 2046 (IR = 575 per 100,000; 95% PI, 402-717 per 100,000) compared with 2013 (IR = 437 per 100,000; 95% CI, 397-479 per 100,000) and the volume to increase by 142%. ConclusionA large increase in the volume of arthroplasties is expected using a conservative projection model that accounts for past surgical trends and future population changes in Australia. These findings have international implications, as they show that using country- specific, conservative projection approaches, a substantial increase in the number of these procedures is expected. This increase in joint arthroplasty volume will require appropriate workforce planning, resource allocation, and budget planning so that demand can be met. Level of EvidenceLevel II, economic and decision analysis.
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Purpose: Rupture of the anterior cruciate ligament (ACL) is a common and debilitating injury that impacts significantly on knee function and risks the development of degenerative arthritis. The outcome of ACL surgery is not monitored in Australia. The optimal treatment is unknown. Consequently, the identification of best practice in treating ACL is crucial to the development of improved outcomes. The Australian Knee Society (AKS) asked the Australian Orthopaedic Association (AOA) to consider establishing a national ACL registry. As a first step, a pilot study was undertaken by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to test the hypothesis that collecting the required information in the Australian setting was possible. Methods: Surgeons completed an operative form which provided comprehensive information on the surgery undertaken. Patients provided pre- and post-operative questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Marx Activity Scale (MA Scale). The number of ACL procedures undertaken at each hospital during the recruitment period was compared against State Government Health Department separation data. Results: A total of 802 patients were recruited from October 2011 to January 2013. The overall capture rate for surgeon-derived data was 99%, and the capture rate for the pre-operative patient questionnaire was 97.9%. At 6 months, patient-reported outcomes were obtained from 55% of patients, and 58.5% of patients at 12 months. When checked against State Government Health Department separation data, 31.3% of procedures undertaken at each study hospital were captured in the study. Conclusion: It is possible to collect surgeon-derived and pre-operative patient-reported data, following ACL reconstruction in Australia. The need to gain patient consent was a limiting factor to participation. When patients did consent to participate in the study, we were able to capture nearly 100% of surgical procedures. Patient consent would not be an issue in for a national registry where inclusion is automatic unless the patient wishes to opt out. The collection of post-operative patient-reported outcome measures (PROMs) is more problematic, due to an insufficient proportion of individuals providing patient-reported outcomes. Alternative outcome measures are required for an ACL registry in Australia to be successfully implemented. Level of evidence: Diagnostic, Level III.
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Background: The anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee for which surgery is performed. United States national estimates of ACL reconstruction vary widely. Purpose: This study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the utilization of inpatient and ambulatory surgery for ACL tears in the United States. Study design: Descriptive epidemiology study. Methods: The National Survey of Ambulatory Surgery, conducted in 1994, 1995, 1996, and 2006 (data from 1994, 1996, and 2006 were used in the study), and the National Hospital Discharge Survey, conducted between 1990 and 2007, were used to identify cases of ACL reconstruction. The data were analyzed for trends in demographics, treatment, and utilization. Results: Between 1994 and 2006, the population-adjusted estimate of the rate of ACL reconstructions increased by 37% (33.0/100,000 capita or 86,837 total procedures to 45.1/100,000 capita or 134,421 total procedures). There was an increase in the proportion of females undergoing reconstruction in both the ambulatory (30% to 40%) and inpatient (29% to 47%) settings over the study period, with a 304% increase in the sex-adjusted estimate of the rate of female ambulatory procedures between 1994 and 2006. Age-adjusted estimates of the rates of ambulatory ACL reconstruction increased among all age groups, with a 924% increase in patients less than 15 years of age. Concurrent meniscectomy remained relatively constant in the ambulatory (37% to 40%) and inpatient (37% to 33%) settings between 1994 and 2007. Private insurance was the largest compensator, representing 77% of cases in 2006. Between 1994 and 2006, the use of peripheral nerve blocks during ambulatory surgery increased from 0.7% to 30.8%. Conclusion: The rate of ACL reconstruction increased dramatically between 1990 and 2007 based on the National Survey of Ambulatory Surgery and National Hospital Discharge Survey databases, which represents the most up-to-date publicly available data. Knowledge of this increase and national practice patterns may aid policy makers and surgeons in appropriately allocating health care resources to ensure quality patient care.
Article
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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.
Article
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Osteoarthritis (OA) is a highly prevalent, disabling disease, with a commensurate tremendous individual and socioeconomic burden. This Perspectives article focuses on the burden of OA for the individual, the health-care system and society, to draw attention to the magnitude of the current problem with some reference to projected figures. We have an urgent opportunity to make fundamental changes to the way we care for individuals with OA that will have an effect upon the direct and indirect costs of this disease. By focusing on the burden of this prevalent, disabling, and costly disease, we hope to highlight the opportunity for shifts in health-care policy towards prevention and chronic-disease management.
Article
Background: Anterior cruciate ligament (ACL) tears are thought to occur with increasing frequency in young patients. No study has shown increased incidence over time. We hypothesized the incidence of ACL tears in young patients has increased over the past 20 years. Methods: This descriptive epidemiology study is a retrospective review of insurance billing data of all patients aged 6 to 18 years with Current Procedural Terminology, Fourth Revision codes for ACL tear and reconstruction or International Classification of Diseases, Ninth Revision, Clinical Modification codes from 1994 to 2013. Injuries were normalized to persons per year enrolled in the insurance database based on age and sex. Analysis was performed based on sex and age (6-14, 15-16, and 17-18 years). Results: The rate of ACL tears per 100 000 person-years averaged 121 ± 19 (range 92-151). All trends increased significantly except for the male 6- to 14-year-old and 17- to 18-year-old age groups. Overall there was an annual increase of 2.3%. Females had significantly higher incidence except in the 17- to 18-year-olds. Females peaked at age 16 years and males at age 17 years, with rates of 392 ACL tears and 422 ACL tears per 100 000 person-years, respectively. Conclusions: The incidence of ACL tears in pediatric patients increased over the last 20 years. Females were at higher risk except in the 17- to 18-year -old group. Peak incidence is noted during high school years. These data help target the most at-risk patients for ACL prevention programs.
Article
Background/aim: Anterior cruciate ligament (ACL) injury is a common and devastating sporting injury. With or without ACL reconstruction, the risk of knee osteoarthritis (OA) and permanent disability later in life is markedly increased. While neuromuscular training programmes can prevent 50-80% of ACL injuries, no national implementation strategies exist in Australia. The aim of this study was to compare the ability of four alternative national universal ACL injury prevention programme implementation strategies to reduce future medical costs secondary to ACL injury. Methods: A Markov economic decision model was constructed to estimate the value in lifetime future medical costs prevented by implementing a national ACL prevention programme among four hypothetical cohorts: high-risk sport participants (HR) aged 12-25 years; HR 18-25 years; HR 12-17 years; all youths (ALL) 12-17 years. Results: Of the four programmes examined, the HR 12-25 programme provided the greatest value, averting US$693 of direct healthcare costs per person per lifetime or US$221 870 880 in total. Without training, 9.4% of this cohort will rupture their ACL and 16.8% will develop knee OA. Training prevents 3764 lifetime ACL ruptures per 100 000 individuals, a 40% reduction in ACL injuries. 842 lifetime cases of OA per 100 000 individuals and 584 TKRs per 100 000 are subsequently averted. Numbers needed to treat ranged from 27 for the HR 12-25 to 190 for the ALL 12-17. Conclusions: The HR 12-25 programme was the most effective implementation strategy. Estimation of the break-even cost of health expenditure savings will enable optimal future programme design, implementation and expenditure.
Article
With the increasing involvement in organized athletics among children and adolescents, more anterior cruciate ligament (ACL) injuries are being recognized in the skeletally immature population. The goal of the present study is to utilize a national database to characterize the recent epidemiologic trends of ACL injuries, ACL reconstruction, and treatment of associated meniscal and chondral pathology in the pediatric and adolescent populations. A national database was queried for ACL tear (ICD-9 844.2) and arthroscopic reconstruction of an ACL tear (CPT 29888) from 2007 to 2011. Searches were limited by age group to identify pediatric and adolescent cohorts: (1) ages 5 to 9 years old, (2) ages 10 to 14 years old, and (3) ages 15 to 19 years old. A comparative cohort of adult patients from ages 20 to 45 was also created. The database was also queried for concomitant procedures at the same time as ACL reconstruction for each age group, including partial meniscectomy, meniscus repair, microfracture, osteochondral autograft or allograft transfer, and shaving chondroplasty. The χ analysis was used to determine statistical significance. A total of 44,815 unique pediatric or adolescent patients with a diagnosis of an ACL tear and 19,053 pediatric or adolescent patients who underwent arthroscopic ACL reconstruction were identified. Significant increases in pediatric and adolescent ACL tear diagnosis and reconstruction compared with adult patients were noted. Significant increases in many concomitant meniscus and cartilage procedures in pediatric and adolescent patients compared with adult patients were also noted. The present study demonstrates a significant increase in the overall diagnosis of ACL injury and ACL reconstruction in both pediatric and adolescent patients, rising at a rate significantly higher than adults. In addition, pediatric and adolescent patients who undergo ACL reconstruction had significant increases in incidences of concomitant meniscal and cartilage procedures. Level III-retrospective cohort study.
Article
Previous sports injury is a known risk factor for subsequent osteoarthritis, but population-based rates of sports injury are unknown. The aims of this study were to: i) describe the trends in the population incidence and burden of all hospital-treated sports injury in Victoria, Australia in adults aged 15+ years; ii) determine the incidence of lower limb and knee injuries; and iii) quantify their population health burden as average direct hospital costs per injury and lengths of stay. Health sector data relating to adults aged 15+ years, for 2004-2010 inclusive, was extracted from the Victorian Admitted Episodes Dataset and Victorian Emergency Minimum Dataset. Data relating to sports injuries were identified using activity codes in each dataset Trends in injury frequency and rates were determined, and economic burden was calculated. The overall annual rate of hospital treated sports injuries increased by 24% (p=0.001), and lower limb injuries by 26% (p=0.001) over the seven years. The associated accumulated economic burden was $265 million for all sports injuries and $110 million for lower limb injuries over the 7-years. The findings of this study show a significant increase in sports injuries in the state of Victoria, Australia over a 7-year period. As previous sports injury is a risk factor for the development of osteoarthritis, the future incidence of osteoarthritis will escalate, placing an even greater burden on health care systems. Population-wide preventative strategies that reduce the risk of sports injury are urgently required in order to reduce the future burden of osteoarthritis. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.