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.