20 years of pediatric anterior cruciate ligament reconstruction in New York State.
BACKGROUND
There have been no population-based studies to evaluate the rate of pediatric anterior cruciate ligament (ACL) reconstruction.


OBJECTIVE
The primary aim of the current study was to determine the yearly rate of ACL reconstruction over the past 20 years in New York State. Secondary aims were to determine the age distribution for ACL reconstruction and determine whether patient demographic and socioeconomic factors were associated with ACL reconstruction.


METHODS
Descriptive epidemiology study.


METHODS
The Statewide Planning and Research Cooperative System (SPARCS) database contains a census of all hospital admissions and ambulatory surgery in New York State. This database was used to identify pediatric ACL reconstructions between 1990 and 2009; ICD-9-CM (International Classification of Diseases, 9 Revision, Clinical Modification) and CPT-4 (Current Procedural Terminology, 4th Revision) codes were used to identify reconstructions. Patient sex, age, race, family income, education, and insurance status were assessed.


RESULTS
The rate of ACL reconstruction per 100,000 population aged 3 to 20 years has been increasing steadily over the past 20 years, from 17.6 (95% confidence interval [CI], 16.4-18.9) in 1990 to 50.9 (95% CI, 48.8-53.0) in 2009. The peak age for ACL reconstruction in 2009 was 17 years, at a rate of 176.7 (95% CI, 160.9-192.5). In 2009, the youngest age at which ACL reconstruction was performed was 9 years. The rate of ACL reconstruction in male patients was about 15% higher than in females, and ACL reconstruction was 6-fold more common in patients with private health insurance compared with those enrolled in Medicaid.


CONCLUSIONS
This study is the first to quantify the increasing rate of ACL reconstructions in the skeletally immature. Only ACL reconstructions were assessed, and it is possible that some ACL tears in children are not diagnosed or are treated nonoperatively. The rate of ACL tears in New York State is likely higher than the rate of reconstructions reported in this study.


CONCLUSIONS
This study quantifies the increasing rate of ACL reconstruction in the skeletally immature and suggests that there may be some disparities in care based on insurance status.
Emily R. Dodwell, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. dodwelle@hss.edu.
Emily R
ER
Dodwell
Lauren E
LE
Lamont
Daniel W
DW
Green
Ting Jung
TJ
Pan
Robert G
RG
Marx
Stephen
S
Lyman
D000293:Adolescent; D017677:Age Distribution; D059549:Anterior Cruciate Ligament Reconstruction / Q000706:statistics & numerical data* / Q000639:trends; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009518:New York; D017678:Sex Distribution; D014481:United States; D055815:Young Adult
disparity; insurance; pediatric ACL reconstruction; pediatric ACL tear