Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway
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Data from large prospectively collected anterior cruciate ligament (ACL) cohorts are being utilized to address clinical questions regarding ACL injury demographics and outcomes of ACL reconstruction. These data are affected by patient and injury factors as well as surgical factors associated with the site of data collection. The aim of this article is to compare primary ACL reconstruction data from patient cohorts in the United States and Norway, demonstrating the similarities and differences between two large cohorts. Primary ACL reconstruction data from the Multicenter Orthopaedic Outcomes Network (MOON) in the United States and the Norwegian National Knee Ligament Registry (NKLR) were compared to identify similarities and differences in patient demographics, activity at injury, preoperative Knee injury and Osteoarthritis Outcome Score (KOOS), time to reconstruction, intraarticular pathology, and graft choice. Seven hundred and thirteen patients from the MOON cohort were compared with 4,928 patients from the NKLR. A higher percentage of males (NKLR 57%, MOON 52%; P < 0.01) and increased patient age (NKLR 27 years, MOON 23 years; P < 0.001) were noted in the NKLR population. The most common sports associated with injury in the MOON cohort were basketball (20%), soccer (17%), and American football (14%); while soccer (42%), handball (26%), and downhill skiing (10%) were most common in the NKLR. Median time to reconstruction was 2.4 (Interquartile range [IQR] 1.2–7.2) months in the MOON cohort and 7.9 (IQR 4.2–17.8) months in the NKLR cohort (P < 0.001). Both meniscal tears (MOON 65%, NKLR 48%; P < 0.001) and articular cartilage defects (MOON 46%, NKLR 26%; P < 0.001) were more common in the MOON cohort. Hamstring autografts (MOON 44%, NKLR 63%) and patellar tendon autografts (MOON 42%, NKLR 37%) were commonly utilized in both cohorts. Allografts were much more frequently utilized in the MOON cohort (MOON 13%, NKLR 0.04%; P < 0.001). Significant diversity in patient, injury, and surgical factors exist among large prospective cohorts collected in different locations. Surgeons should investigate and consider the characteristics of these cohorts when applying knowledge gleaned from these groups to their own patient populations.
KeywordsACL Meniscus KOOS Epidemiology Articular cartilage
MOON Acknowledgments This work was partially supported by the Vanderbilt Sports Medicine Research Fund, by a Grant from the NIH NIAMS #1 R01AR053684-01 A1 (Spindler—PI), by a Grant from the NIH #5 K23 AR052392-03 (Dunn—PI), and by unrestricted educational gifts from DonJoy and Smith & Nephew Endoscopy.
The authors thank the Research Coordinators at the MOON sites for their diligent assistance and cooperation, and Lynn S. Cain for editorial assistance in the preparation of this manuscript.
NKLR Acknowledgments The NKLR is financed by the Oslo Sports Trauma Research Center, which has been established through generous grants from the Eastern Norway Regional Health Authority, the Royal Norwegian Ministry of Culture, the Norwegian Olympic Committee & Confederation of Sport, and Norsk Tipping AS. In addition, the NKLR has been supported through a grant from the Norwegian Medical Association’s Fund for Quality Improvement. Lars-Petter Granan has been supported by the Medical Research Curriculum at the University of Oslo.
The authors wish to thank Kjersti Steindal, computer engineer, for extracting the data from the National Knee Ligament Registry; NKLR secretaries, Ruth Gunvor Wasmuth and Marianne Wiese; and the staff and colleagues of the participating orthopedic and surgical departments for their cooperation.
Conflict of interest statement
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Norwegian Eastern Health Corporate, Royal Norwegian Ministry of Culture, Norwegian Olympic Committee and Confederation of Sport, Norsk Tipping AS, and Pfizer AS. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
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