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Increasing incidence of anterior cruciate ligament reconstruction: a 17-year population-based study

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Anterior cruciate ligament (ACL) injuries are one of the most frequently studied injuries in orthopedic care and research. However, limited epidemiological data are available in Canada regarding trend and distribution of anterior cruciate ligament reconstruction (ACLR). In this paper, our purpose was to assess trends of ACLR between 2002/03 and 2018/19 by age, sex, season of surgery, and location (inpatient vs outpatient) of surgery.

Methods

In this descriptive epidemiological study of retrospective data available from Alberta Ministry of Health, we report annual incidence of ACLR between 2002/03 until 2018/19 among Albertans aged 10 years and older. Information was collected by authors from physician claims database for primary ACLR and revision ACLR and linked with other databases. Incidence proportions (number of ACLR/100,000 population) were calculated and compared by age category and gender over the study period.

Results

A total of 28,401 primary ACLR and 2085 revision ACLR were identified during the study period. Age-standardized annual incidence of primary ACLR increased from 40.6 to 51.2 per 100,000 population aged 10 years and older. Average annual increase in ACLR incidence was higher among females (1.8% per years) compared to males (0.96% per year). The overall peak incidence and peak incidence among males was observed in 20–29 year age group, whereas peak incidence in females was observed in 10–19 years of age. The number of ACLR in females outnumbers those among males for 10–19 year age group. Generally, a lower proportion of ACLR were conducted in summer compared to other seasons. Primary ACLR conducted in outpatient setting increased from 72% in 2002/03 to 97% in 2018/19.

Conclusion

The incidence of ACLR is increasing in Alberta, especially among females and among younger cohorts under 20 years of age. This information can help clinicians to provide patient education and policy-makers to design and implement targeted ACL injury prevention programs.

Level of evidence

Level III.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

NACRS:

National ambulatory care reporting system

DAD:

Discharge abstract database

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Acknowledgements

We would like to thank Alberta Ministry of Health for providing the data for this study. This study is based in part on data provided by Alberta Health. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta. Neither the Government nor Alberta Health expresses any opinion in relation to this study.

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Authors and Affiliations

  1. School of Public Health, University of Alberta, Edmonton, AB, Canada

    Yuba Raj Paudel & Don Voaklander

  2. Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Mark Sommerfeldt

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  1. Yuba Raj Paudel
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Contributions

This study is a part of first author’s doctoral thesis. All authors contributed substantially to the conception and design of the study. DV and YRP were responsible for acquisition of data. YRP conducted the analysis and wrote the original draft of manuscript. MS and DV contributed to review, and interpretation of data. All authors approved the final version of this manuscript.

Corresponding author

Correspondence to Yuba Raj Paudel.

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We declare that there is no conflict of interest.

Ethical approval

This study was approved by the University of Alberta Human Research Committee (Pro00090820).

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Since we used deidentified patient records from Alberta Ministry of Health, informed consent was not required.

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Paudel, Y., Sommerfeldt, M. & Voaklander, D. Increasing incidence of anterior cruciate ligament reconstruction: a 17-year population-based study. Knee Surg Sports Traumatol Arthrosc 31, 248–255 (2023). https://doi.org/10.1007/s00167-022-07093-1

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