Use of a Continuous All-inside Meniscal Repair Device Produces Excellent Outcomes for Meniscal Repair in Patients With and Without Concurrent ACL Reconstruction

INTRODUCTION: An increased rate of pediatric and adolescent patients undergoing ACL reconstruction has clearly been established, and now considered one of the most common arthroscopic procedures performed in youth patients. Little knowledge exists on whether these trends truly represent an increase in ACL injury, identification, or surgical management. Trends, including surgeon training, meniscus treatment, or geographic differences, have not been reported. The purpose of this study was to review data from ACL reconstructions performed in patients under the age of 17 years, that were submitted to the American Board of Orthopaedic Surgeons (ABOS) Part 2 examination, with a goal of evaluating national treatment trends over a 16-year period. METHODS: A query to the ABOS SCRIBE database was submitted for all ACL reconstructions performed in patients less than 17 years old between 2002 and 2016. The query was designed to search for CPT procedure codes submitted by each applicant. Query data included geographic region, fellowship training of the applicant, age and sex of the patients, and associated procedures. Each case had an associated applicant number, and thus, the total number of ACL reconstructions performed by each surgeon during board collection was provided. Trends were reviewed for the aggregate data and a Mann-Whitney test was used for comparison of data between 2002 – 2009 (Early-ACL) and 2010-2016 (Recent-ACL) groups. RESULTS: Since 2002, there has been a 2.6% increase in pediatric ACL reconstructions performed by candidates applying for Part 2 of the ABOS examination. Additionally, a 193% increase in dual pediatric and sports medicine fellowship trained candidates performing pediatric ACL reconstruction since 2010 was seen. A majority of pediatric ACL procedures were performed by sports medicine trained surgeons (75.9%). During this time period, a total of 362 (or 8.3%) of pediatric ACL procedures were performed by surgeons with neither sports medicine nor pediatric orthopaedic fellowship training. Following 2009, a 44% increase in pediatric ACL reconstructions performed was noted (Figure 1A). Additionally, an increase in reconstructions performed in female patients compared to males was noted (Figure 1B). A majority of pediatric ACL reconstructions did not require additional meniscal treatment, however, meniscus repair was more likely to be performed after 2009 (p=0.0012). The number of meniscal repair procedures reported in the setting of ACL reconstruction generally increased over the study period. In 2002, 24% of ACL reconstructions required a meniscal repair compared to 41% in 2016 (Figure 1C). A majority of these repairs were performed by surgeons with sports medicine fellowship training. Geographic trends reported are based on patients <16 per available census records (Figure 1D). Geographic variation exists with of the highest rates of pediatric ACL reconstructions occurring in the South (4.62 per million) and Midwest (4.07 per million) in comparison to the Southeast (1.85 per million). When adjusting for population size per year, each region saw a significant increase in reported ACL surgeries from the Early-ACL to the Recent-ACL timeframe (p=0.005). The largest increases in surgeries reported between Early-ACL and Recent-ACL were seen in the Southeast (68% increase), Midwest (50% increase) and Southwest (47% increase). Of all the providers who performed surgery, 74% submitted only 1-2 cases from 2002-2016, with 26% of providers performing more than 55% of all of the pediatric ACL reconstruction cases. More than 75% of all cases were performed by sports medicine fellowship trained surgeons However, a large change was seen in dual sports and pediatric trained surgeon case volumes over this time period, with these surgeons performing 7.5 times more surgeries from 2010 to 2016 (Recent-ACL) when compared to 2002-2009 (Early-ACL). CONCLUSION: Since 2009, pediatric ACL reconstructions are more likely to be female and are more likely to undergo a meniscal repair. Geographic variation is noticeable, with more surgeries reported to be performed in the South. Dual pediatric and sports medicine fellowship trained candidates performing ACL reconstruction have significantly increased over time, although those surgeons who are only sports medicine fellowship trained continue to perform the bulk of ACL reconstructions in young patients.

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The effects of partial meniscectomy and meniscal repair on the knee proprioception and function

Journal of Orthopaedic Surgery ◽

10.1177/2309499019894915 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949901989491 ◽

Cited By ~ 2

Author(s):

Betül Başar ◽

Gökhan Başar ◽

Ahmet Aybar ◽

Akif Kurtan ◽

Hakan Başar

Keyword(s):

Acl Reconstruction ◽

Meniscal Tear ◽

Meniscal Repair ◽

Partial Meniscectomy ◽

Acl Rupture ◽

Knee Motion ◽

Female Patients ◽

Group 2 ◽

And Function ◽

Group 1

Purpose: Aim of our study was to compare the effects of partial meniscectomy and meniscus repair on knee proprioception and function. Methods: The study included 46 patients with clinical and radiological diagnosis of meniscal tear and accompanying anterior cruciate ligament (ACL) rupture. The patients were evaluated under two groups: group 1: partial meniscectomy and ACL reconstruction, and group 2: meniscal repair and ACL reconstruction. Proprioceptive and functional evaluation of all patients was performed prior to surgery and on postoperative 12th month. Results: Group 1 consists of 18 male and 1 female patients with an average age of 28.78 ± 3.50. Group 2 consists of 23 male and 4 female patients with an average age of 27.14 ± 3.65. Preoperative evaluation revealed significant differences in knee joint position sense values on wide range of knee motion (15°, 30°, 45°, 60°, and 75°) in both groups. The statistically significant difference was observed in only the range of knee motion of 60° in patients underwent meniscal repair (group 2), whereas in the range of knee motion of 45°, 60°, and 75° in patients underwent partial meniscectomy (group 1) at 12th-month control. According to Lysholm knee scoring system, significantly better results were achieved with meniscal repair compared to the partial meniscectomy at 12th-month control. Conclusion: In case of ACL rupture accompanied by meniscal tear, the meniscal repair should be sutured, if possible, in order to obtain better results in terms of knee function and proprioception.

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Predictors of Radiographic Osteoarthritis 2-3 Years after ACL Reconstruction: Data from MOON Onsite Nested Cohort

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00348 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0034

Author(s):

Morgan H. Jones ◽

Sameer R. Oak ◽

Jack T. Andrish ◽

Robert H. Brophy ◽

Charles L. Cox ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Meniscal Repair ◽

Cartilage Lesion ◽

Partial Meniscectomy ◽

Medial Compartment ◽

Acl Tear ◽

Increased Risk ◽

And Cartilage

Objectives: Multiple studies have shown patients are susceptible to post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) injury even with ACL reconstruction (ACLR). Prospective studies using multivariate analysis to identify risk factors for PTOA are lacking. This study aims to identify baseline predictors of radiographic PT OA after ACLR at an early time point and hypothesizes that meniscal injury and cartilage lesions will be associated with worse radiographic OA using the Osteoarthritis Research Society International (OARSI) atlas criteria. Methods: 421 patients who underwent ACLR returned onsite for standardized posteroanterior metatarsophalangeal radiographs a minimum of 2 years after surgery. At baseline, demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up. Results: The mean age was 19.8 years with 51.3% females. Higher age (odds ratio (OR) 1.06) and BMI (OR 1.05) were statistically significantly associated with higher OARSI grade in the medial compartment. Patients with a meniscal repair and a partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR 1.92 and meniscectomy OR 2.11) and in the lateral compartment (meniscal repair OR 1.96 and meniscectomy OR 2.97). Graft type, cartilage lesion, sex, and Marx activity scales had no significant association with OARSI grade. Conclusion: Older patients with a higher BMI who have an ACL tear with concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic OA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at increased risk of developing radiographic knee OA at 2-3 years following ACLR.

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Outcomes After Biologically Augmented Isolated Meniscal Repair With Marrow Venting Are Comparable With Those After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546516686968 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1341-1348 ◽

Cited By ~ 34

Author(s):

Chase S. Dean ◽

Jorge Chahla ◽

Lauren M. Matheny ◽

Justin J. Mitchell ◽

Robert F. LaPrade

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Intercondylar Notch ◽

Inclusion Criteria ◽

Significant Difference ◽

Outcome Scores ◽

Anterior Cruciate ◽

Biological Augmentation

Background: Meniscal repair in the setting of anterior cruciate ligament (ACL) reconstruction has demonstrated superior outcomes compared with isolated meniscal repair. Limited evidence exists for the effects of biological augmentation in isolated meniscal repair, particularly as compared with meniscal repair with concomitant ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to compare the outcomes and survivorship of meniscal repair in 2 cohorts of patients: meniscal repair with biological augmentation using a marrow venting procedure (MVP) of the intercondylar notch, and meniscal repair with concomitant ACL reconstruction. We hypothesized that the clinical outcomes and survivorship of meniscal repair with concomitant ACL reconstruction would be improved compared with meniscal repair with biological augmentation. Study Design: Cohort study; Level of evidence, 3. Methods: Inclusion criteria were skeletally mature patients aged ≥16 years who underwent inside-out meniscal repair and either a concomitant MVP of the intercondylar notch or ACL reconstruction. Patients were excluded from this study if they were skeletally immature, underwent meniscus root or radial tear repair, or underwent meniscal repair with concurrent ligamentous reconstruction not limited to the ACL. At the preoperative evaluation and a minimum 2 years after the index meniscal repair procedure, patients were administered a subjective questionnaire. Differences in outcome scores, survivorship, and failure rates between the cohorts were assessed. Failure was defined as reoperation with meniscectomy or revision meniscal repair. Results: There were 109 patients (52 female, 57 male) who met the inclusion criteria for this study. There were 37 knees in cohort 1 (isolated meniscal repair plus MVP) and 72 knees in cohort 2 (meniscal repair plus ACL reconstruction). The failure status was known in 95 patients, and patient-reported outcome scores were obtained in 89 (82%) patients. Both cohorts demonstrated a significant improvement in all outcome scores, and there was no significant difference in any of the preoperative or postoperative outcome measures. The overall failure rate was 9.5% (9/95). There were 4 (12.9%) failures in cohort 1 and 5 failures (7.8%) in cohort 2, with no significant difference in failures between the cohorts ( P = .429). There was a significant association between failure and female sex ( P = .001). Conclusion: The most important finding in this study was that there was no difference in outcomes in meniscal repair performed with biological augmentation using an MVP versus that performed concomitantly with ACL reconstruction. The similar outcomes reported for meniscal repair with an MVP and meniscal repair with ACL reconstruction may be partly attributed to biological augmentation.

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Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction

Joints ◽

10.11138/jts/2015.3.3.151 ◽

2015 ◽

Vol 03 (03) ◽

pp. 151-157 ◽

Cited By ~ 5

Author(s):

Davide Deledda ◽

Federica Rosso ◽

Umberto Cottino ◽

Davide Bonasia ◽

Roberto Rossi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Ligament Reconstruction ◽

Medial Meniscus ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Meniscal Tears ◽

Acl Injuries ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

Meniscal tears are commonly associated with anterior cruciate ligament (ACL) injuries. A deficient medial meniscus results in knee instability and could lead to higher stress forces on the ACL reconstruction.Comparison of results in meniscectomy and meniscal repairs revealed worse clinical outcomes in meniscectomy, but higher re-operation rates in meniscal repairs. Our aim was to review the results of ACL reconstruction associated with meniscectomy or meniscal repair.

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Prevalence, Development, and Factors Associated with Cyst Formation after Meniscal Repair with the All-Inside Suture Device

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00321 ◽

2020 ◽

Vol 8 (5_suppl4) ◽

pp. 2325967120S0032

Author(s):

Thore Zantop ◽

Yusuke Hashimoto ◽

Hiroaki Nakamura

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Acl Reconstruction ◽

Prevalence Rate ◽

Medial Meniscus ◽

Meniscal Repair ◽

Cyst Formation ◽

Knee Instability ◽

Suture Anchors ◽

Suture Device

Aims and Objectives: The aim of this study is to investigate the prevalence of cyst formation as a complication of all-inside meniscal suture device using magnetic resonance imaging (MRI) and analyze the risk factors. Materials and Methods: Of the patients who had undergone meniscal repair surgery 46 cases (46 knees) were selected to be in the case-control study. 51 menisci (34 medial menisci, 17 lateral menisci) of 46 cases were included to the study. Out of 51 menisci, 46 menisci combined anterior cruciate ligament (ACL) ruptures and had performed ACL reconstruction (ACLR). 5 cases (5 menisci) had been performed meniscal repair (MR). MRIs of the knee were performed 6, 12 and 24 months post-meniscal surgery. The MRIs were examined to detect the new development of cysts encasing the suture anchors and evaluate meniscal healing. Univariate and multivariate risk factor analyses was used to account for the suture technique (suture device alone versus suture device and inside-out suture repair), concurrent operation (MR alone versus MR with ACL reconstruction), patient gender, medial versus lateral menisci, number of device use, side-to-side difference of knee arthrometer, type of anchor (acetal resin versus PEEK material) and clinical scores (Lysholm score, Tegner activity scale, IKDC score). Results: MRI examinations revealed cyst formation in 15 of 51 menisci. 3 menisci were detected cyst formation at 6 months of surgery, 9 at 12 months and 3 at 24 months. Only 3 patients (6.5%) were symptomatic. Tecxhniques using suture device alone was more likely to develop cysts: odds ratio (OR) was 10.67 (95% confidence interval (CI) 1.25 to 91.41). Medial meniscus statistically tended to develop cyst compared with lateral meniscus and OR was 7.92 (95% confidence interval (CI) 1.23 to 51.07). Patients who have instability (side-to-side difference of knee arthrometer > 3mm) are more likely to develop cysts than that ofless than or equal to 3mm (p = 0.06). Conclusion: This study revealed the risk factors and prevalence rate for cyst formation after using the all-inside meniscal suture device. The prevalence rate of cyst formation around suture implant was 29%, however most cases didn’t have any symptoms. Suture device only and medial meniscus were significant risk factors for cyst formation. Knee instability was greater in the cyst developed menisci though it was not significant, which suggested that knee instability could affect cyst formation around suture anchors.

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Meniscal Repair with Concurrent Anterior Cruciate Ligament Reconstruction: Is ACL Graft Choice Predictive of Meniscal Repair Success?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00359 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0035

Author(s):

Hytham S. Salem ◽

Laura J. Huston ◽

Alex Zajichek ◽

Michelle Lora Wolcott ◽

Eric C. McCarty ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Meniscal Repair ◽

Acl Graft ◽

Baseline Activity ◽

Graft Choice ◽

Significant Difference ◽

Anterior Cruciate

Objectives: The success rate of meniscal repair is known to increase with concurrent anterior cruciate ligament (ACL) reconstruction. However, the influence of ACL graft choice has not been described. The current study examines the effect of ACL graft choice on the outcome of meniscal repair performed in conjunction with ACL reconstruction (ACLR). Methods: Patients who underwent meniscal repair with concurrent primary ACLR were identified from a longitudinal, prospective cohort. Patient demographics and subjective outcome measures including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale were collected preoperatively. Arthroscopic assessment of meniscal tear characteristics and associated repair technique were recorded intraoperatively. Patients with subsequent repair failure, defined as any subsequent surgical procedure addressing the meniscus repaired at index surgery, were identified and operative notes were obtained in order to accurately classify pathology and treatment. A logistic regression model was built to assess the association of patient specific factors, ACL graft, baseline Marx activity level and meniscal tear laterality with the occurrence of repair failure at 6-year follow-up. Results: A total of 646 patients underwent ACLR with concurrent meniscal repair. Bone-patellar tendon-bone (BTB) and soft tissue (ST) autograft were used in 55.7% and 33.9% of cases, respectively, while allografts were utilized in the remaining cases. Table 1 summarizes the univariate analysis of each baseline variable. A total of 101 patients (15.6%) required subsequent surgery on the meniscus repaired at index surgery, including 89 meniscectomies (87 partial, 2 subtotal), 11 revision meniscal repairs, and 1 meniscus allograft transplantation. No statistically significant difference in meniscal repair failure rate was observed based on patient age, sex, BMI or smoking status. The odds of meniscal repair failure within 6 years of surgery for patients with only a lateral meniscal repair are 68% less than those with only a medial meniscal repair (CI: 41%, 83%; p<0.001). There is a statistically significant relationship between baseline Marx activity and the risk of subsequent meniscal repair, though it is nonlinear—patients with low or high baseline activity are at the highest risk of meniscal repair failure (CI: 1.05,1.31; p=0.004, Figure 1). The estimated odds of meniscal repair failure for BTB allograft, ST allograft, and ST autograft were 2.78 (CI: 0.84,9.19; p=0.09), 2.29 (CI: 0.97,5.45; p=0.06), and 1.42 (CI:0.87,2.32; p=0.16) times that of BTB autograft, respectively, although none proved statistically significant. Meniscal repair failure is associated with significantly lower 6-year scores for all KOOS components and the IKDC (p<0.001). However, there was no significant difference in MARX activity at 6-years (p=0.27). Conclusion: In the setting of primary ACLR, the risk of meniscal repair failure is increased with medial versus lateral meniscal repair. Patients with low or high baseline activity levels are also at an increased risk. ACL graft choice seems to have an effect on meniscal repair failure that approaches but does not reach statistical significance. A larger sample size may be required to accept the null hypothesis. [Table: see text][Figure: see text]

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Results of arthroscopic meniscal repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00010 ◽

2017 ◽

Vol 5 (1_suppl) ◽

pp. 2325967117S0001

Author(s):

María Belén Orlowski ◽

Damián Arroquy ◽

Jorge Chahla ◽

Jorge Guiñazú ◽

Martín Carboni Bisso ◽

...

Keyword(s):

Success Rate ◽

Acl Reconstruction ◽

Failure Rate ◽

Clinical Success ◽

Intraoperative Complications ◽

Meniscal Repair ◽

Careful Selection ◽

Meniscal Suture ◽

Selection Of Patients ◽

Selection Of

Objectives: Currently the arthroscopic treatment of meniscal pathology has become one of the most common procedures in orthopedic practice and although in most cases meniscectomy is done, meniscal sutures are the treatment of choice when a reparable lesion is diagnosed, especially in young patients. It has been reported that the meniscal repair leads to a lower incidence of developing degenerative changes in the long-term when compared with meniscectomy and nonsurgical treatment of meniscal injuries. The aim of this study was to determine the success rate of meniscal repair achieved in our sports medicine practice. Methods: Between 2006 and 2015, 62 meniscal tears in 58 patients with a mean age of 31 years (range 15-58) were repaired. Mean follow-up was 52 months (range 6-120 months). In 16 patients (28%) was associated with arthroscopic ACL reconstruction. The repair techniques used included outside-in sutures, inside-out sutures, all-inside sutures and a combination of techniques. Failure of the repair was defined by the requirement for repeat knee arthroscopy and partial or subtotal meniscectomy. The indication of arthroscopic revision was based on the presence of mechanical symptoms, after the suture. Results: Failure of meniscus repair occurred in four patients (failure rate: 6.45%), one case was associated with ACL reconstruction (failure rate: 6.25%) and 3 had undergone isolated meniscal suture (failure rate: 8%). The average time for the reoperation was 15 months (4-24). We had no intraoperative complications. Conclusion: The reported failure rate of meniscal repair in stable knees varies between 12% and 43%, with reports that demonstrate a clinical success rate of 100%. In this study, we obtained a success rate of 93.5%. These results are slightly higher than those in the literature, which can be attributed to careful selection of patients and the fact that clinical success tends to be better than the assessed arthroscopically. In summary, we consider the meniscal repair as a successful option in the treatment of meniscal rupture. Due to the importance it has recovered in the last time preserving the meniscus, in the future we should greatly increase our rate of meniscal suture. We hold that careful selection of patients and the type of injury to repair, optimizes the success of meniscal repairs.

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Seventeen-Year Follow-up After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction in a Pediatric and Adolescent Population

The American Journal of Sports Medicine ◽

10.1177/0363546518803934 ◽

2018 ◽

Vol 46 (14) ◽

pp. 3361-3367 ◽

Cited By ~ 5

Author(s):

Adam J. Tagliero ◽

Vishal S. Desai ◽

Nicholas I. Kennedy ◽

Christopher L. Camp ◽

Michael J. Stuart ◽

...

Keyword(s):

Acl Reconstruction ◽

Clinical Success ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Clinical Success Rate ◽

Adolescent Population ◽

Long Term Follow Up ◽

Anterior Cruciate

Background: Studies have shown good and excellent clinical and radiographic results after meniscal repair. Limited published information exists on the long-term outcomes, however, especially in a pediatric and adolescent population. Purpose: To determine long-term results of meniscal repair and concomitant anterior cruciate ligament (ACL) reconstruction in a pediatric and adolescent population. Specifically, the aims were to determine the clinical success rate of meniscal repair with concomitant ACL reconstruction, compare results with midterm outcomes, and analyze risk factors for failure. Study Design: Case series; Level of evidence, 4. Methods: Cases of meniscal repair with concomitant ACL reconstruction between 1990 and 2005 were reviewed among patients aged ≤18 years. Patient demographics, injury history, and surgical details were recorded, and risk factors for failure were analyzed. Physical examination findings and clinical outcomes at latest available follow-up were collected. Subjective knee outcomes were compared with midterm results. Descriptive statistics and univariate analysis were used to evaluate the available data. Results: Forty-seven patients (30 females, 17 males) with a mean age of 16 years (SD, 1.37) and a mean follow-up of 16.6 years (SD, 3.57) were included in this study. Overall, 13 patients (28%) failed meniscal repair and required repeat surgery at the time of final follow-up. Of the 13 failures, 9 underwent a subsequent meniscectomy; 2, meniscectomy and revision ACL reconstruction; 1, meniscal repair and revision ACL reconstruction; and 1, meniscal repair and subsequent meniscectomy. Mean International Knee Documentation Committee scores improved from 47.9 preoperatively to 87.7 postoperatively ( P < .01), and the mean score at long-term follow-up (87.7) did not significantly differ from that at the midterm follow-up (88.5) at a mean 7.4 years ( P = .97). Mean Tegner Activity Scale scores improved from 1.9 preoperatively to 6.3 postoperatively ( P < .01) and decreased from 8.3 at preinjury to 6.3 at final long-term follow-up ( P < .01). Conclusion: In conclusion, the long-term overall clinical success rate (failure-free survival) was 72% for repair of pediatric and adolescent meniscal tears in the setting of concomitant ACL reconstruction. Patients reported excellent knee subjective outcome scores that remained favorable when compared with midterm follow-up.

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

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118803616 ◽

2018 ◽

Vol 10 (6) ◽

pp. 523-531 ◽

Cited By ~ 32

Author(s):

Mackenzie M. Herzog ◽

Stephen W. Marshall ◽

Jennifer L. Lund ◽

Virginia Pate ◽

Christina D. Mack ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Children And Adolescents ◽

Acl Reconstruction ◽

Clinical Epidemiology ◽

Cruciate Ligament ◽

Meniscal Repair ◽

The United States ◽

Care Utilization ◽

Meniscal Surgery

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.

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