Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injury and Reconstruction

J Pediatr Orthop. 2016 Jul-Aug;36(5):447-52. doi: 10.1097/BPO.0000000000000482.


Background: With the increasing involvement in organized athletics among children and adolescents, more anterior cruciate ligament (ACL) injuries are being recognized in the skeletally immature population. The goal of the present study is to utilize a national database to characterize the recent epidemiologic trends of ACL injuries, ACL reconstruction, and treatment of associated meniscal and chondral pathology in the pediatric and adolescent populations.

Methods: A national database was queried for ACL tear (ICD-9 844.2) and arthroscopic reconstruction of an ACL tear (CPT 29888) from 2007 to 2011. Searches were limited by age group to identify pediatric and adolescent cohorts: (1) ages 5 to 9 years old, (2) ages 10 to 14 years old, and (3) ages 15 to 19 years old. A comparative cohort of adult patients from ages 20 to 45 was also created. The database was also queried for concomitant procedures at the same time as ACL reconstruction for each age group, including partial meniscectomy, meniscus repair, microfracture, osteochondral autograft or allograft transfer, and shaving chondroplasty. The χ analysis was used to determine statistical significance.

Results: A total of 44,815 unique pediatric or adolescent patients with a diagnosis of an ACL tear and 19,053 pediatric or adolescent patients who underwent arthroscopic ACL reconstruction were identified. Significant increases in pediatric and adolescent ACL tear diagnosis and reconstruction compared with adult patients were noted. Significant increases in many concomitant meniscus and cartilage procedures in pediatric and adolescent patients compared with adult patients were also noted.

Conclusions: The present study demonstrates a significant increase in the overall diagnosis of ACL injury and ACL reconstruction in both pediatric and adolescent patients, rising at a rate significantly higher than adults. In addition, pediatric and adolescent patients who undergo ACL reconstruction had significant increases in incidences of concomitant meniscal and cartilage procedures.

Level of evidence: Level III-retrospective cohort study.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries / complications
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods
  • Anterior Cruciate Ligament Reconstruction / trends*
  • Arthroscopy / methods
  • Arthroscopy / trends*
  • Athletic Injuries / surgery
  • Bone Transplantation / methods
  • Bone Transplantation / trends
  • Cartilage / transplantation
  • Cartilage, Articular / surgery*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Knee Injuries / surgery
  • Male
  • Menisci, Tibial / surgery
  • Middle Aged
  • Retrospective Studies
  • Tibial Meniscus Injuries / complications
  • Tibial Meniscus Injuries / surgery
  • Transplantation, Autologous
  • Transplantation, Homologous
  • Young Adult