Trends in Anterior Cruciate Ligament Reconstruction in the United States

Abstract

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.

Keywords: ACL; anterior cruciate ligament reconstruction; epidemiology; meniscectomy.

Figure 1.

Volume of inpatient and ambulatory national anterior cruciate ligament reconstructions in 1994, 1996, and 2006.

Figure 2.

Proportion of outpatient anterior cruciate ligament reconstructions performed in a freestanding ambulatory surgery center versus hospital-based ambulatory center.

Figure 3.

Primary source of payment for inpatient and outpatient anterior cruciate ligament reconstructions between 1990 and 2007. HMO, health maintenance organization; NHDS, National Hospital Discharge Survey; NSAS, National Survey of Ambulatory Surgery; PPO, preferred provider organization.