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Decline in Pediatric Anterior Cruciate Ligament Reconstructions Seen Over 20 Years in the American Board of
V Claire Clark1, Meagan J Sabatino, Daniel R G Lind
1From the Scottish Rite for Children Orthopaedic and Sports Medicine Center, Frisco, TX (Ms. Clark, Mr. Van Pelt, Dr. Wilson, and Dr. Ellis); UMass Chan Medical School, Worcester, MA (Ms. Sabatino); University of Texas Southwestern Medical Center, Dallas, TX (Dr. Wilson and Dr. Ellis); Children's Medical Center, Dallas, TX (Dr. Wilson and Dr. Ellis); Steadman Philippon Research Institute, Vail, CO (Lind); Children's Hospital Colorado, Aurora, CO (Dr. Vandenberg); Boulder Medical Center, Boulder, CO (Dr. Beck); Pediatric Orthopaedics & Scoliosis Center, Rady Children's Hospital, San Diego, CA (Dr. Pennock); Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University, Hasbro Children's Hospital, Providence, RI (Dr. Cruz); Children's Hospital of Philadelphia, Philadelphia, PA (Dr. Ganley); and Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA (Dr. Shea).
Introduction:
Although increased treatment of pediatric anterior cruciate ligament (ACL) injury is well-documented, surrounding trends remain unknown. We evaluated national trends over 21 years using data from pediatric ACL reconstructions (ACLR) submitted to the American Board of Orthopaedic Surgeons (ABOS) Part II Oral Examination and compared fellowship training, geographic variation, and case volume trends.
Methods:
The ABOS SCRIBE database was queried for ACLR in pediatric (<19) patients between 2000 and 2021. Data included geographic region, fellowship training, and patient demographics. ACLRs per capita was estimated using census data. Data were stratified by age and sex. Multiple linear regression assessed whether year, sex, and age/sex category predicted surgery number.
Results:
From 2000 to 2021, ABOS Part II candidates reported 12,124 pediatric ACLR. Nearly 2/3 were in patients 16 years or older. Most were in the Midwest (22.8%) and South (22.2%). Each region decreased in ACLR. Overall, pediatric ACLR decreased 31.3% and contributing surgeons decreased 40.4%. Female ACLR increased 39.5% from 2009 to 2014, with 11.9% more than male patients in 2014. After 2014, sex differences and total ACLR decreased. 81.3% were reported by surgeons with sports medicine training and 6.0% with dual sports medicine and pediatric orthopaedics fellowships. Dual training increased in 2009 and declined after 2013. Surgeries in male patients compared with female patients (B = -6.777, 95% confidence interval, -9.534 to -4.279) and male patients 16 to 18 years compared with male patients younger than 16 years (B = -4.935, 95% confidence interval, -6.596 to -3.273) decreased.
Conclusion:
Pediatric ACLR performed by ABOS Part II candidates decreased overall, but a concern for increased ACLR in female patients persists. More surgeries were done in the Midwest and South.
Study Design:
Cross-sectional Study Level of Evidence: III.
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