Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries - Luxembourg, USA, Denmark, Norway, Sweden, UK
Heather A Prentice 1, Martin Lind 2, Caroline Mouton 3, Andreas Persson 4, 5, Henrik Magnusson 6, Ayman Gabr 7,
Romain Seil 3, Lars Engebretsen 4, 5, Kristian Samuelsson 8, Jon Karlsson 8, Magnus Forssblad 9, Fares S Haddad 10,
Tim Spalding 11, Tadashi T Funahashi 12, Liz W Paxton1, Gregory B Maletis 13
1 - Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA
2 - Division of Sports Surgery, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
3 - Department of Orthopaedic Surgery, Clinique d’Eich-Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
4 - Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
5 - Norwegian Knee Ligament Registry, Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
6 - Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
7 - Trauma and Orthopaedic Department, University College London Hospitals, NHS Foundation Trust, London, UK
8 - Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
9 - Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
10 - Department of Trauma and Orthopaedics, University College London Hospitals, London, UK
11 - University Hospitals Coventry and Warwickshire (UHCW), Coventry, UK
12 - Department of Orthopaedics, Southern California Permanente Medical Group, Irvine, California, USA
13 - Department of Orthopaedics, Southern California Permanente Medical Group, Baldwin Park, California, USA
Findings from individual anterior cruciate ligament reconstruction (ACLR) registry studies are impactful, but how various registries from different countries compare with different patient populations and surgical techniques has not been described. We sought to describe six ACLR registry cohorts to understand variation across countries.
Five European registries and one US registry participated. For each registry, all primary ACLR registered between registry establishment through 31December 2014 were identified. Descriptive statistics included frequencies, proportions, medians and IQRs. Revision incidence rates following primary ACLR were computed.
101 125 ACLR were included: 21 820 in Denmark, 300 in Luxembourg, 17 556 in Norway, 30 422 in Sweden, 2972 in the UK and 28 055 in the US. In all six cohorts, males (range: 56.8%–72.4%) and soccer injuries (range: 14.1%–42.3%) were most common. European countries mostly used autografts (range: 93.7%–99.7%); allograft was most common in the US (39.9%). Interference screw was the most frequent femoral fixation in Luxembourg and the US (84.8% and 42.9%), and suspensory fixation was more frequent in the other countries (range: 43.9%–75.5%). Interference was the most frequent tibial fixation type in all six cohorts (range: 64.8%–98.2%). Three-year cumulative revision probabilities ranged from 2.8% to 3.7%.
Similarities in patient demographics and injury activity were observed between all cohorts of ACLR. However, graft and fixation choices differed. Revision rates were low. This work, including >100 000 ACLR, is the most comprehensive international description of contemporary practice to date.