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

Mackenzie M Herzog, Stephen W Marshall, Jennifer L Lund, Virginia Pate, Christina D Mack, Jeffrey T Spang, Mackenzie M Herzog, Stephen W Marshall, Jennifer L Lund, Virginia Pate, Christina D Mack, Jeffrey T Spang

Abstract

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.

Keywords: ACL; ACL reconstruction; anterior cruciate ligament; epidemiology; meniscus surgery.

Conflict of interest statement

<?release-delay 12|0>The following authors declared potential conflicts of interest: Mackenzie M. Herzog, MPH, and Jeffrey T. Spang, MD, are supported by a University of North Carolina at Chapel Hill Junior Faculty Development Award, and Stephen W. Marshall, PhD, is supported by grants from the Department of Defense and the National Institutes of Health.

Figures

Figure 1.
Figure 1.
Annual trends in incidence rate of inpatient versus outpatient anterior cruciate ligament reconstruction per 100,000 person-years (PYs) among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014.
Figure 2.
Figure 2.
Annual trends in incidence rate of open versus arthroscopic anterior cruciate ligament reconstruction per 100,000 person-years (PYs) among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014.
Figure 3.
Figure 3.
Annual trends in incidence rate of anterior cruciate ligament (ACL) reconstruction with concomitant procedures per 100,000 person-years (PYs) among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014. MCL, medial collateral ligament; PCL, posterior cruciate ligament.
Figure 4.
Figure 4.
Annual trends in incidence rate of anterior cruciate ligament (ACL) reconstruction with concomitant procedures per 100,000 person-years (PYs) comparing (a) males and (b) females among patients included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014. MCL, medial collateral ligament; PCL, posterior cruciate ligament.
Figure 5.
Figure 5.
Annual trends in incidence rate of anterior cruciate ligament (ACL) reconstruction with concomitant procedures per 100,000 person-years (PYs) comparing (a) 40-year-olds included in the Truven Health Analytics MarketScan Commercial Claims and Encounters database 2002-2014. MCL, medial collateral ligament; PCL, posterior cruciate ligament.

References

    1. Aizcorbe A, Liebman E, Pack S, Cutler DM, Chernew ME, Rosen AB. Measuring health care costs of individuals with employer-sponsored health insurance in the U.S.: a comparison of survey and claims data. Stat J IAOS. 2012;28:43-51.
    1. Bates NA, McPherson AL, Rao MB, Myer GD, Hewett TE. Characteristics of inpatient anterior cruciate ligament reconstructions and concomitant injuries. Knee Surg Sports Traumatol Arthrosc. 2016;24:2778-2786.
    1. Commercial Claims and Encounters Medicare Supplemental Source: Truven Health MarketScan Research Databases. Data Year 2013 Edition. Ann Arbor, MI: Truven Health Analytics; 2013.
    1. Dare D, Rodeo S. Mechanisms of post-traumatic osteoarthritis after ACL injury. Curr Rheumatol Rep. 2014;16:448.
    1. Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A. Meniscus pathology, osteoarthritis and the treatment controversy. Nat Rev Rheumatol. 2012;8:412-419.
    1. Fetzer GB, Spindler KP, Amendola A, et al. Potential market for new meniscus repair strategies: evaluation of the MOON cohort. J Knee Surg. 2009;22:180-186.
    1. Flynn RK, Pedersen CL, Birmingham TB, Kirkley A, Jackowski D, Fowler PJ. The familial predisposition toward tearing the anterior cruciate ligament: a case control study. Am J Sports Med. 2005;33:23-28.
    1. Gornitzky AL, Lott A, Yellin JL, Fabricant PD, Lawrence JT, Ganley TJ. Sport-specific yearly risk and incidence of anterior cruciate ligament tears in high school athletes: a systematic review and meta-analysis. Am J Sports Med. 2016;44:2716-2723.
    1. Herzog MM, Marshall SW, Lund JL, Pate V, Mack CD, Spang JT. Incidence of anterior cruciate ligament reconstruction among adolescent females in the United States, 2002 through 2014. JAMA Pediatr. 2017;171:808-810.
    1. Jacobs JJ, King TR, Klippel JH, et al. Beyond the decade: strategic priorities to reduce the burden of musculoskeletal disease. J Bone Joint Surg Am. 2013;95:e1251-e1256.
    1. Joseph AM, Collins CL, Henke NM, Yard EE, Fields SK, Comstock RD. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train. 2013;48:810-817.
    1. Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. 2011;93:994-1000.
    1. Leathers MP, Merz A, Wong J, Scott T, Wang JC, Hame SL. Trends and demographics in anterior cruciate ligament reconstruction in the United States. J Knee Surg. 2015;28:390-394.
    1. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am. 2009;91:2321-2328.
    1. Mall NA, Chalmers PN, Moric M, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42:2363-2370.
    1. Mather RC, 3rd, Koenig L, Kocher MS, et al. Societal and economic impact of anterior cruciate ligament tears. J Bone Joint Surg Am. 2013;95:1751-1759.
    1. Nelson F, Billinghurst RC, Pidoux I, et al. Early post-traumatic osteoarthritis-like changes in human articular cartilage following rupture of the anterior cruciate ligament. Osteoarthritis Cartilage. 2006;14:114-119.
    1. Nordenvall R, Bahmanyar S, Adami J, Mattila VM, Fellander-Tsai L. Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. a population based nationwide study in Sweden, 1987-2009. PLoS One. 2014;9:e104681.
    1. Parker BR, Hurwitz S, Spang J, Creighton R, Kamath G. Surgical trends in the treatment of meniscal tears: analysis of data from the American Board of Orthopaedic Surgery Certification Examination Database. Am J Sports Med. 2016;44:1717-1723.
    1. Pugely AJ, Martin CT, Harwood J, Ong KL, Bozic KJ, Callaghan JJ. Database and registry research in orthopaedic surgery: part I: claims-based data. J Bone Joint Surg Am. 2015;97:1278-1287.
    1. Singh JA, Kundukulam JA, Bhandari M. A systematic review of validated methods for identifying orthopedic implant removal and revision using administrative data. Pharmacoepidemiol Drug Saf. 2012;21(suppl 1):265-273.
    1. vonPorat A Roos EM Roos H.. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63:269-273.
    1. Wilder FV, Hall BJ, Barrett JP, Jr, Lemrow NB. History of acute knee injury and osteoarthritis of the knee: a prospective epidemiological assessment. The Clearwater Osteoarthritis Study. Osteoarthritis Cartilage. 2002;10:611-616.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다