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. 2021 Sep 24;9(9):23259671211040891.
doi: 10.1177/23259671211040891. eCollection 2021 Sep.

Contemporary Practice Patterns for the Treatment of Anterior Cruciate Ligament Tears in the United States

Nicolas Cevallos  1 , Kylen K J Soriano  1 , Drew A Lansdown  1 , C Benjamin Ma  1 , Brian T Feeley  1 , Alan L Zhang  1
Affiliations

Contemporary Practice Patterns for the Treatment of Anterior Cruciate Ligament Tears in the United States

Nicolas Cevallos et al. Orthop J Sports Med. .

Abstract

Background: There is a lack of research investigating current practice trends in the treatment of anterior cruciate ligament (ACL) tears as well as common concomitant procedures and reoperations associated with ACL reconstruction (ACLR).

Purpose: To analyze current practice patterns for ACLR as well as the frequency of concomitant and revision procedures with respect to patient characteristics in a cross-sectional population of the United States.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Patient data between 2010 and 2017 were queried using the Mariner PearlDiver database. International Classification of Diseases, Ninth Revision (in 2010-2014) and Tenth Revision (ICD-10; in 2015-2017), diagnosis codes were used to identify ACL tears, and Current Procedural Terminology codes were used to identify ACLR and concomitant surgical procedures. Patient characteristics were stratified by sex and age. Cases of subsequent knee surgery and conversion to total knee arthroplasty (TKA) within 2 years after ACLR were tracked using ICD-10 codes between 2015 and 2017 to ensure ipsilateral laterality.

Results: Of 229,295 patients identified with an ACL tear diagnosis during the study period, 75% underwent ACLR. In patients aged 10 to 39 years, 84% to 92% underwent ACLR, while patients aged 50 to 59 (50%) and 60 to 69 (28%) years were less likely to have surgery after an ACL tear. Female and male patients underwent ACLR at a similar rate (75%). Within the patients who underwent ACLR, 44% underwent concomitant meniscal debridement as compared with 11% with concomitant meniscal repair. Male patients were more likely to undergo meniscal debridement (48% vs 40%; P < .0001). The frequency of meniscal repair increased from 9% in 2010 to 14% in 2017, while the frequency of meniscal debridement decreased from 47% to 41% (P < .0001). Within 2 years of ACLR, 6% of patients underwent revision ACLR; 4%, subsequent meniscal debridement; 1%, meniscal repair; and 1%, conversion to TKA.

Conclusion: The frequency of ACLR for ACL tears has remained relatively stable in recent years and was similar between female and male patients in this cross-sectional population. The majority of patients aged 10 to 39 years underwent ACLR, while less than half of patients >50 years underwent surgery.

Keywords: ACL reconstruction; ACL tear; characteristics; revision ACL; trend.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: D.A.L. has received grant support and education payments from Arthrex, Evolution Surgical, and Smith & Nephew and hospitality payments from Wright Medical. C.B.M. has received grant support from Anika, Histogenics, Samumed, and Zimmer and personal fees from ConMed Linvatec, Histogenics, Medacta, SLACK, Stryker, and Wright Medical. B.T.F. has received grant support from Zimmer and consulting fees from Kaliber Labs. A.L.Z. has received grant support from Zimmer, education payments from Arthrex, and consulting fees from DePuy Mitek and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Percentage of patients with anterior cruciate ligament (ACL) tear diagnosis who underwent ACL reconstruction, stratified by age group.
Figure 2.
Figure 2.
Percentage of patients with anterior cruciate ligament (ACL) tear diagnosis who underwent ACL reconstruction, stratified by age group and sex.
Figure 3.
Figure 3.
Percentage of anterior cruciate ligament (ACL) reconstruction cases with concomitant procedures by (A) procedure, (B) year, and (C) age group.
Figure 4.
Figure 4.
Percentage of patients who underwent subsequent surgery within 2 years of anterior cruciate ligament (ACL) reconstruction by (A) procedure and (B) age group. TKA, total knee arthroplasty.
See this image and copyright information in PMC

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