Peripandemic Utilization of Primary Anterior Cruciate Ligament Reconstruction in a United States-Based Integrated Health Care System, 2017-2023.

Introduction: Prior studies reporting the utilization of anterior cruciate ligament reconstruction (ACLR) was limited to pediatric populations or lacked accounting for the impact of the COVID-19 pandemic. In this study, the authors sought to compare the annual incidence of primary ACLR following the COVID-19 pandemic shutdown to see if utilization has rebounded to pre-pandemic levels.

Methods: The number of ACLRs performed per year from 2017 through 2023 was identified from the authors' health care system's ACLR interregional registry, and average membership per year was identified from membership records. Incidence rates per 100,000 members were calculated for each year. Poisson regression was used to evaluate year-to-year trends overall and across graft selection, age, and gender. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) are presented.

Results: In total, 23,082 ACLRs were performed from 2017 to 2023. Pre-pandemic, annual ACLR incidence increased from 47.0 per 100,000 in 2017 to 50.2 in 2019. During the pandemic (2020), this dropped by 33.9% to 33.2 per 100,000 (IRR, 0.66; 95% CI, 0.63-0.70). Post-pandemic, annual incidence increased from 38.6 to 42.3 per 100,000 from 2021 to 2023, respectively (2020 to 2021: IRR, 1.16; 95% CI, 1.10 -1.23; 2021 to 2022: IRR, 1.11; 95% CI, 1.06-1.16). However, this was still lower than the pre-pandemic incidence. In both genders, patients in the pediatric age groups had the biggest declines during the shutdown (drop off of 57% in the 10- to 14-year-old group and 40% in the 15- to 19-year-old group).

Discussion: The COVID-19 pandemic shutdown of elective orthopedic procedures led to a sharp drop in the numbers of ACLRs performed, and the United States is still in the recovery period.