Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study

Am J Sports Med. 2016 Jun;44(6):1502-7. doi: 10.1177/0363546516629944. Epub 2016 Feb 26.


Background: The incidence of isolated anterior cruciate ligament (ACL) tears in the general population is not well defined.

Purpose/hypothesis: The purpose of this study was to define the population-based incidence of ACL tears, describe trends in ACL injuries over time, and evaluate changes in the rate of surgical management. The hypothesis was that the incidence of ACL injury and the rate of subsequent ACL reconstruction increase over time.

Study design: Cohort study; Level of evidence, 3.

Methods: The study population included 1841 individuals who were diagnosed with new-onset, isolated ACL tears (without concomitant ligament injury that required surgery) between January 1, 1990, and December 31, 2010. The complete medical records were reviewed to confirm diagnosis and to extract injury and treatment details. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 US population. Poisson regression analyses were performed to examine incidence trends by age, sex, and calendar period.

Results: The overall age- and sex-adjusted annual incidence of ACL tears was 68.6 per 100,000 person-years. Incidence was significantly higher in male patients than in females (81.7 vs 55.3 per 100,000, P < .001). The incidence of isolated ACL tears decreased significantly over time in males (P < .001) but remained relatively stable in females. Age-specific patterns differed in male and female patients, with a peak in incidence (241.0 per 100,000) between 19 and 25 years in males and a peak in incidence (227.6 per 100,000) between 14 and 18 years in females. The rate of ACL reconstruction increased significantly over time in all age groups (P < .001).

Conclusion: With an annual incidence of 68.6 per 100,000 person-years, isolated ACL tears remain a common orthopaedic injury. Differences in age-specific incidence trends in male and female patients may potentially reflect differences in sports participation patterns through the high school and college years. The significant increase in the rate of ACL reconstruction over time may reflect changing surgical indications or an increasing desire among patients to return to high levels of activity after ACL injury.

Keywords: ACL reconstruction; ACL tear; epidemiology; incidence.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Anterior Cruciate Ligament Injuries / epidemiology*
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction*
  • Athletic Injuries / epidemiology
  • Athletic Injuries / surgery
  • Female
  • Humans
  • Incidence
  • Male
  • Minnesota / epidemiology
  • Retrospective Studies
  • Sex Distribution
  • Young Adult