A study from the Hospital for Special Surgery (HSS) suggests that orthopedic surgeons are seeing an “epidemic” of anterior cruciate ligament (ACL) injuries among athletes. Additionally, the study indicates that a large number of patients who have surgery to reconstruct a torn ACL undergo a second knee operation later on.
In an HSS news release, Emily Dodwell, MD, MPH, lead investigator and pediatric orthopedic surgeon at HSS, explains that the study evaluates “on a population level, the percentage of patients under age 21 who had subsequent ACL or non-ACL knee surgery following a primary anterior cruciate ligament reconstruction.”
The release notes that researchers compiled statistics from a New York State database and found that 8% of patients with a primary ACL reconstruction had another ACL surgery, and 14% had non-ACL knee surgery at a later date.
Researchers pinpointed patients under the age of 21 who had surgery for a torn ACL between the years of 1997 and 2010 using the Statewide Planning and Research Cooperative System (SPARCS) database for New York State. The release says patients were tracked for a subsequent ACL reconstruction knee surgery for another surgery, such as a torn meniscus, at a later date.
Investigators identified 23,912 primary pediatric ACL reconstructions in New York State. Out of those patients, 1,955 patients (8.2%) had a subsequent ACL reconstruction, and 3,341 patients (14%) had subsequent non-ACL knee surgery.
According to the release, the median time lapse between the first and second ACL surgery was 1.6 years. The median time lapse between the first ACL reconstruction and surgery for another knee injury was 1.4 years. The median length of follow-up for all patients was 6.7 years, the release states.
Factors reportedly linked to requiring a second ACL surgery included younger age at time of the first ACL repair; being male; Caucasian ethnicity; private insurance; higher hospital ACL volume; and higher surgeon ACL volume. The release says factors linked to a second knee surgery for a non-ACL injury were younger age; being female; Caucasian ethnicity; private insurance; and higher hospital ACL volume.
In the release, the researchers acknowledge that the study may underestimate the actual number of repeat ACL tears, as the database only included patients who underwent surgery, and did not include those who chose not have additional surgery.
Dodwell notes that while the growing number of ACL injuries is concerning, it is not a surprise given greater participation in sports. The study also says children are beginning sports at a younger age, playing for longer durations with greater intensity, and often concentrating on a single sport year round, resulting in overuse and acute injuries.
“For young people who have primary surgery to reconstruct a torn ACL, it is troubling that they have relatively high rates of subsequent ACL reconstruction or surgery for another knee injury. Further research is needed to determine factors associated with subsequent injury and surgery so we can implement strategies to keep our youth safe while engaging in sports,” Dodwell says.
The release says that in order to support the research needed, HSS recently received a $2.76 million dollar grant from a private foundation to establish a program designed to prevent ACL injuries in young atheltes.
The 5-year endeavor, known as the HSS Sports Medicine Injury Prevention Program, is slated to begin by reviewing best practices based on the latest research. The release reports that the hospital will then launch a comprehensive campaign to raise awareness, informing and education the public and professionals about injury prevention.
An initial emphasis will be placed on preventing ACL tears, the release says.