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. 2018 Nov/Dec;10(6):523-531.
doi: 10.1177/1941738118803616.

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

Mackenzie M Herzog  1   2   3 , Stephen W Marshall  1   2   4 , Jennifer L Lund  1 , Virginia Pate  1 , Christina D Mack  1   3 , Jeffrey T Spang  5
Affiliations

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

Mackenzie M Herzog et al. Sports Health. 2018 Nov/Dec.

Abstract

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.

Keywords: ACL; ACL reconstruction; anterior cruciate ligament; epidemiology; meniscus surgery.

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Conflict of interest statement

The following authors declared potential conflicts of interest: Mackenzie M. Herzog, MPH, and Jeffrey T. Spang, MD, are supported by a University of North Carolina at Chapel Hill Junior Faculty Development Award, and Stephen W. Marshall, PhD, is supported by grants from the Department of Defense and the National Institutes of Health.

Figures

Figure 1.
Figure 1.
Annual trends in incidence rate of inpatient versus outpatient anterior cruciate ligament reconstruction per 100,000 person-years (PYs) among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014.
Figure 2.
Figure 2.
Annual trends in incidence rate of open versus arthroscopic anterior cruciate ligament reconstruction per 100,000 person-years (PYs) among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014.
Figure 3.
Figure 3.
Annual trends in incidence rate of anterior cruciate ligament (ACL) reconstruction with concomitant procedures per 100,000 person-years (PYs) among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014. MCL, medial collateral ligament; PCL, posterior cruciate ligament.
Figure 4.
Figure 4.
Annual trends in incidence rate of anterior cruciate ligament (ACL) reconstruction with concomitant procedures per 100,000 person-years (PYs) comparing (a) males and (b) females among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014. MCL, medial collateral ligament; PCL, posterior cruciate ligament.
Figure 5.
Figure 5.
Annual trends in incidence rate of anterior cruciate ligament (ACL) reconstruction with concomitant procedures per 100,000 person-years (PYs) comparing (a) <13-year-olds, (b) 13- to 17-year-olds, (c) 18- to 30-year-olds, (d) 31- to 40-year-olds, and (e) >40-year-olds included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014. MCL, medial collateral ligament; PCL, posterior cruciate ligament.
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