Brodeur Peter G, Licht Aron H, Modest Jacob M, Testa Edward J, Gil Joseph A, Cruz Aristides I
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Am J Sports Med. 2022 Apr;50(5):1222-1228. doi: 10.1177/03635465221074694. Epub 2022 Mar 2.
There are limited epidemiologic data examining the incidence of pediatric anterior cruciate ligament reconstruction (ACLR) over the past decade.
To examine statewide population trends in the incidence of ACLR in a pediatric population.
Descriptive epidemiology study.
Inpatient and outpatient claims for pediatric patients who underwent ACLR between 2009 and 2017 were identified in the New York Statewide Planning and Research Cooperative System database via International Classification of Diseases (ICD), Revision 9, Clinical Modification; ICD, Revision 10, Clinical Modification and Procedural Classification System; or Current Procedural Terminology codes. New York population data for each year between 2009 and 2017 were used from the New York State Department of Health to calculate the rates of ACLR per 100,000 people aged 3 to 19 years and determine the 95% confidence limits. The rates were then stratified by age, sex, and insurance. Two-year rates of revision and contralateral ACLR were also analyzed by sex.
Between 2009 and 2017, 20,170 pediatric ACLRs were identified. The rates of pediatric ACLR increased steadily from 49.3 per 100,000 in 2009 (95% CI, 47.2-51.4) to a peak of 61.0 (95% CI, 58.6-63.4) in 2014 and decreased to 51.8 (95% CI, 49.6-54.1) by 2017. The age group 15 to 17 years had the highest rates of ACLR of all age groups, peaking at 198.5 (95% CI, 188.3-208.7) per 100,000. Analysis by sex showed that ACLR rates between males and females were not different. Males had a 2-year ipsilateral revision rate of 4.3%, while females had a rate of 3.3% ( = .0001). Females had a contralateral ACLR rate of 4.0%, while males had a rate of 2.6% ( = .0002).
Pediatric ACLR rates continued to rise until 2014, but there was a demonstrable decrease in rates after 2014. This decline in pediatric ACLR may point to the efficacy of injury prevention programs or changes in practice management. The high revision rate in males and high contralateral surgery rate in females can help guide patient counseling for return to play and complication risk.
This study showed that ACLR in pediatric patients may be decreasing in recent years. There were differences in revision and contralateral ACLR by sex.
过去十年间，关于儿童前交叉韧带重建术（ACLR）发病率的流行病学数据有限。
研究儿童人群中ACLR发病率的全州人口趋势。
描述性流行病学研究。
通过国际疾病分类（ICD）第9版临床修订本、ICD第10版临床修订本和程序分类系统或当前程序术语代码，在纽约全州规划与研究合作系统数据库中识别2009年至2017年间接受ACLR的儿科患者的住院和门诊索赔。使用纽约州卫生部提供的2009年至2017年每年的纽约人口数据来计算每10万名3至19岁人群的ACLR发生率，并确定95%置信区间。然后按年龄、性别和保险进行分层。还按性别分析了两年翻修率和对侧ACLR率。
2009年至2017年间，共识别出20170例儿童ACLR。儿童ACLR发生率从2009年的每10万例49.3例（95%CI为47.2 - 51.4）稳步上升至2014年的峰值61.0例（95%CI为58.6 - 63.4），到2017年降至51.8例（95%CI为49.6 - 54.1）。15至17岁年龄组的ACLR发生率在所有年龄组中最高，峰值为每10万例198.5例（95%CI为188.3 - 208.7）。按性别分析显示，男性和女性之间的ACLR发生率没有差异。男性的两年同侧翻修率为4.3%，而女性为3.3%（P = 0.0001）。女性的对侧ACLR率为4.0%，而男性为2.6%（P = 0.0002）。
儿童ACLR发生率在2014年之前持续上升，但2014年之后明显下降。儿童ACLR的这种下降可能表明预防损伤计划的有效性或实践管理的变化。男性的高翻修率和女性的高对侧手术率有助于指导患者关于恢复运动和并发症风险的咨询。
本研究表明，近年来儿科患者的ACLR可能在减少。翻修和对侧ACLR在性别上存在差异。
