Cumulative Incidence of ACL Reconstruction After ACL Injury in Adults: Role of Age, Sex, and Race
Open accessAbstract
Background: Anterior cruciate ligament (ACL) injuries are common and potentially disabling and frequently prompt surgical reconstruction. The utilization of ACL reconstruction among ACL-injured patients has not been examined rigorously. Purpose: This study reports the 3-year cumulative incidence of ACL reconstruction among adults with ACL injury and compares demographic and clinical characteristics of ACL-injured patients who do and do not go on to undergo ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A tertiary health care system patient data repository was used to identify patients diagnosed with an ACL injury between January 1, 2001, and December 31, 2007. Follow-up data were obtained to determine how many patients with ACL injury underwent ACL reconstruction within 3 years of ACL injury diagnosis. Stratified analyses were used to examine incidence rates separately by sex, age, race, primary language, socioeconomic status (SES), and health insurance status. Multivariable logistic regression models were built to examine the association of patient characteristics with utilization of ACL reconstruction. Results: There were 2304 patients, with a mean age of 47 years, diagnosed with an ACL injury between 2001 and 2007. The 3-year cumulative incidence of ACL reconstruction after ACL injury diagnosis was 22.6% (95% CI, 20.9%-24.3%). Eighty-six percent of patients undergoing reconstruction did so within 6 months of injury diagnosis, while 94% underwent reconstruction within 1 year. In multivariable models, several patient features were independently associated with a higher adjusted odds of undergoing ACL reconstruction, including male sex (adjusted odds ratio [aOR], 1.4; 95% CI, 1.1-1.7), younger age (aOR per decade, 1.8; 95% CI, 1.7-2.0), white race (aOR, 1.4; 95% CI, 0.94-1.9), higher SES (aOR, 1.4; 95% CI, 1.04-1.8 for high vs low SES; aOR, 1.3; 95% CI, 1.02-1.8 for medium vs low SES), and private health insurance versus self-pay (aOR, 1.9; 95% CI, 1.04-3.5). Conclusion: Less than a quarter of patients with a diagnosed ACL injury underwent ACL reconstruction in the 3 years after diagnosis. The odds of having surgery were higher for men, whites, younger patients, patients with higher SES, and patients with private health insurance.
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There is evidence of institutional gender bias in recommending ACL reconstruction surgery more often to boys/men.
“Like previous work which found surgical treatment options were more frequently offered to men, 85 there is evidence of a similar institutional gender bias in recommending ACL reconstruction surgery more often to boys/men.88”
From Anterior cruciate ligament injury: towards a gendered environmental approach (2021) · cites this paper as [88]
The Results (page unavailable) report that men with ACL injuries underwent reconstruction more often than women, including after adjustment for other measured factors. But the study measured surgeries performed, not whether surgery was recommended or whether the difference reflected institutional bias. The Methods (Setting; page unavailable) specify that the cohort included adults only, so it does not support the claim about boys. (LLM, conf=0.90)
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References 13 · Cited by 110
- Authors
- Collins, J. E., Katz, J. N., Donnell-Fink, L. A., Martin, S. D., & Losina, E.
- Affiliations
- Boston University (US)
- Brigham and Women's Hospital (US)
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Corresponding author
- Collins, Jamie E.
- Venue
- The American Journal of Sports Medicine
- Publisher
- SAGE Publications
- Published
- 2013-01-09
- Volume
- 41
- Issue
- 3
- Pages
- 544-549
- ISSN
- 0363-5465 (ISSN-L)
- 1552-3365
- PMC
- PMC3896975
- OpenAlex
- W2157805920
- Semantic Scholar
- 0ba8e0b22f3f98bbf821a13d5f1a5437208e4db8
- Cited by
- 110
- References
- 13
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 15 · 2023: 7 · 2022: 5 · 2021: 11 · 2020: 11 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 9 · 2015: 6 · 2014: 9 · 2013: 4 · 2012: 1
- FWCI
- 9.19
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The American Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60AR047782, K24AR057827, T32AR055885)
- National Center for Research Resources (UL1RR025758)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- anterior cruciate ligament injury, anterior cruciate ligament reconstruction, cumulative incidence, surgical utilization, socioeconomic status, health insurance status, sex differences, racial differences, age differences, patient characteristics, knee injury, health disparities, self-pay patients, private health insurance, health care utilization, adults, health care costs, health care access
- MeSH terms
- Anterior Cruciate Ligament Injuries, Adult, Age Factors, Aged, Female, Financing, Personal, Medicare, Humans, Insurance, Health, Male, Middle Aged, Registries, Sex Factors, Social Class, United States, Cohort Studies, Incidence, Multivariate Analysis, Likelihood Functions, Anterior Cruciate Ligament, White People, Young Adult, Anterior Cruciate Ligament Reconstruction, Time-to-Treatment
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