Trends in Pediatric Anterior Cruciate Ligament Reconstruction: The Effect of COVID-19

Abstract

Context: The number of pediatric anterior cruciate ligament reconstructions (ACLRs) occurring yearly increased almost 6-fold from 2004 to 2014. Interestingly, there are limited recent data on rates of ACL injury and reconstruction in children and adolescents, especially in the context of COVID-19. Objective: Given the impact of the COVID-19 pandemic on youth sports seasons and the postponement of many elective surgeries, we sought to examine the changes in rates of ACLR during this period. Design: Retrospective cohort study. Setting: This study used the Pediatric Health Information System (PHIS) database to identify eligible patients at PHIS-participating hospitals nationwide from January 2016 to June 2021, with March 1, 2020 considered the “start” of the COVID-19 pandemic. Patients or Other Participants: Using CPT codes, patients 18 years old and younger who underwent ACLR surgery were identified. Interventions: None. Main Outcome Measures: Patient demographics and overall rates of surgery pre- and intra-pandemic were compared. Data were analyzed using bivariate, mixed model, and time series analyses. Results: A total of 24,843 ACLRs were identified during this time period. In total, 1,853 fewer surgeries were performed after March 2020 than expected given pre-pandemic trends. Examining demographics, intra-pandemic, there was an increase in the proportion of patients who identified as White and with private insurance and a decrease in the proportion who identified as Black and with public insurance. There was also a significant shift in the proportion of ACLRs by region, with increased surgeries performed in the Midwest and decreased in the Northeast. In the model adjusted for hospital-level variability, only race and insurance status remained significant. Conclusions: Based on pre-pandemic trends, there were fewer patients than projected who underwent ACLR once the pandemic began, likely due to a combination of decreased rates of injury and delayed surgery.

Pediatric ACL Reconstruction in Children—An Evaluation of the Transphyseal Technique’s Efficacy and Safety

“…This reduction was likely attributed to a decrease in injury rates combined with delays in surgical procedures. It is important to conduct further research to evaluate the impact on these patients [24].…”

Pediatric anterior cruciate ligament tears and associated lesions: Epidemiology, diagnostic process, and imaging

“…Notably, there has been a disparate impact of the pandemic on patients depending on their race and insurance status. 41 In Europe, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy. (ESSKA) has promoted the Pediatric Anterior Cruciate Ligament Initiative (PAMI) registry, which began in 2018 and has recently presented the preliminary results of the recruitment and follow-up experience of the first 100 patients.…”

“…60 In open physis patients with normal radiographs, it is important also to consider the presence of a chondral spine avulsion; the avulsed fragment may appear as a double-POsterior Cruciate Ligament (PCL) sign. 41 MRI is also the most accurate imaging method to detect the presence of concomitant meniscal and chondral injuries with a high degree of reliability. 61 The prevalence of bone bruises in pediatric patients with ACL tears is high, close to 70% of the cases.…”

“…Notably, there has been a disparate impact of the pandemic on patients depending on their race and insurance status. 41 …”

“…60 In open physis patients with normal radiographs, it is important also to consider the presence of a chondral spine avulsion; the avulsed fragment may appear as a double-POsterior Cruciate Ligament (PCL) sign. 41 …”