Trends and Demographics in Anterior Cruciate Ligament Reconstruction in the United States

Abstract

The purpose of this study was to identify the trends and demographics of patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction in the United States. Patients who underwent arthroscopic ACL reconstruction between 2004 and 2009 were identified by searching Current Procedural Terminology codes in the PearlDiver Patient Record Database (PearlDiver Technologies, Fort Wayne, IN). The year of procedure, age, gender, and region of the United States were recorded for each patient. Associated meniscal procedures and the absence or presence of a femoral nerve block were also recorded. The incidence of ACL reconstruction significantly increased over the study period, from 40.9 cases per 10,000 patients in 2004 to 47.8 in 2009 (p < 0.001). Of these cases, 92.8% were associated with either meniscectomy or meniscal repair. ACL reconstruction was performed most commonly in patients aged 10 to 29 years (p < 0.001). A significant male predominance was observed with an incidence ratio of male-to-female of 2.03 (p < 0.001). The frequency of females undergoing ACL reconstruction as a proportion of the total number of annual cases increased from 2,295 in 2004 to 3,476 in 2009 (p = 0.0031). A significant increase in the annual proportion of ACL reconstruction performed under femoral nerve block was also observed, from 2.0% in 2004 to 8.3% in 2009 (p < 0.001). The greatest incidence of ACL reconstruction occurred in the Western region of the United States. An increase in the rate of arthroscopic ACL reconstruction was observed between 2004 and 2009 and 92.8% of the ACL reconstructions were associated with a meniscal procedure. The majority of cases were performed in patients aged 10 to 29 years, with a male predominance. Increases were observed in the number of female cases and proportion performed under a femoral nerve block. The Western region of the United States was found to have a higher incidence of ACL reconstruction.

Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

“…As the number of primary ACLRs is increasing, revision ACLR is becoming increasingly important. 18,19 Failure analysis is a vital element of preoperative planning for revision ACLR. According to the current literature, incorrect tunnel placement is the most common cause of primary ACLR failure.…”

Geographic variation in fasciotomy during operative management of tibia fractures

“…A multitude of incidence and demographic studies of orthopedic injury have been used the PearlDiver database since 2010. [6][7][8][9][10][11][12][13][14][15][16][17] PearlDiver provided state totals of operatively managed tibia fractures and state totals of patients who have had both a lower extremity fasciotomy and an operatively managed tibia fracture from 2007 to 2011. State procedure volumes less than eleven were censored by PearlDiver to protect patient privacy.…”

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

“…Regional anesthesia with the use of peripheral nerve blocks in the form of single injections or catheter placements with the option for prolonged infusions is becoming increasingly popular in orthopaedics. [56][57][58] Additionally, when surveyed, most orthopaedic surgeons are receptive to regional anesthesia for their patients. 56,59 Single injections or infusions are typically amide local anesthetics such as lidocaine, bupivacaine, or ropivacaine with additives to prolong the duration of blockade such as dexamethasone, clonidine, epinephrine, buprenorphine, tramadol, midazolam, and sodium bicarbonate.…”