Trends of Pediatric Anterior Cruciate Ligament Reconstruction Surgery in Korea: Nationwide Population-Based Study

Abstract

Background/Objective: The rise in sports participation among children and adolescents has led to an increase in ACL injuries in skeletally immature individuals. This study analyzed nationwide trends in the anterior cruciate ligament (ACL) reconstruction surgeries in pediatric and adolescent populations, addressing concerns about growth plate disturbances with surgery and risks of secondary injuries with nonoperative treatment. Methods: We conducted a retrospective population-based cohort study using the National Health Insurance Corporation database in South Korea, analyzing ACL reconstruction trends from 2011 to 2018. Patients were categorized into four age groups (≤12 years, 13-15 years, 16-17 years, and ≥18 years). The Chi-square linear-by-linear association test was used to analyze trends in procedural volumes, age groups, and regions. Poisson regression was used to examine whether differences over time were statistically significant by modeling count data and estimating incidence rate ratios (IRRs) with 95% confidence intervals (CIs). It also evaluates the statistical differences by age, gender, and hospital location. Results: A total of 83,132 patients underwent ACL reconstruction during the study period. The ≤12-year-old group accounted for a stable, low percentage of surgeries (16.6% in 2011 to 23.7% in 2018) with no significant trends observed (IRR = 0.99, p = 0.683). Conversely, significant increases were noted in patients aged 13-15 years (IRR = 1.04, p < 0.001), 16-17 years (IRR = 1.03, p < 0.001), and aged ≥18 years (IRR = 1.03, p < 0.001). Male patients and urban hospital locations were associated with higher surgical rates. Conclusions: During the study period, ACL reconstruction is rare in children ≤12 years old due to concerns about growth disturbances, while adolescents 13-17 years old show increased surgical rates due to evolving practices supporting early intervention. These findings emphasize the need for individualized treatment balancing early benefits and growth plate risks.

Keywords: ACL injuries; ACL reconstruction; epidemiology; growth plate; pediatric orthopedics; skeletally immature patients; sports injuries.

Figure 1

The annual number of surgeries performed within one year, categorized by age.