Nationwide Epidemiology of Hospitalized Acute ACL Ruptures in Romania: A 7-Year Analysis (2017-2023)

Background and Objectives: Anterior cruciate ligament (ACL) rupture is one of the most frequent and debilitating knee injuries, especially among young, physically active individuals. While extensively studied in Western countries, large-scale epidemiological data from Eastern Europe remain scarce. This study offers the first nationwide assessment of hospitalization-based incidence of acute ACL rupture in Romania. Materials and Methods: We conducted a retrospective analysis of all hospital discharges coded as S83.53 (ACL rupture) between 2017 and 2023, using national public health datasets. Incidence rates were calculated per 100,000 inhabitants based on the 2021 national census. Data were analyzed by sex, age, year, and region. Results: A total of 4332 ACL-related discharges were recorded (3130 males and 1202 females), yielding an average incidence of 3.23 per 100,000 per year. Incidence in males was consistently higher (up to 5.63) than in females (up to 2.10). The peak incidence occurred in 2023, while the lowest was observed in 2020, likely due to COVID-19-related restrictions. Linear regression showed a significant upward trend over time (R² = 0.966, p < 0.001). The highest age-specific incidence was found in males aged 25-29 years (116.3/100,000) and in females aged 15-19 years (35.4/100,000). Cases were rare above the age of 50. Geographically, incidence varied widely, with Bucharest, Timiș, and Bihor recorded the highest rates, while several other counties reported near-zero values. Conclusions: This study provides the first nationwide analysis of hospitalization-based ACL rupture incidence in Romania, revealing marked differences by age, sex, and region. While the findings reflect only acute cases requiring inpatient care, they underscore the need for more comprehensive injury surveillance, improved access to orthopedic services, and targeted prevention strategies tailored to high-risk populations.