Search

Background Limitations exist with current ACLR functional testing assessments that may be mitigated by including single-leg multi-directional testing. Hypothesis/Purpose To compare Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI) scores, limb symmetry index (LSI) of the single-leg vertical jump (SLVJ), single-leg medial rotation hop (SLMRH), single-leg lateral hop (SLLH), and isokinetic quadriceps strength between participants with an ACLR and healthy controls and assess predictors of quadriceps strength asymmetry. It was hypothesized that ACL-RSI scores and LSIs for all tests would differ between ACLR and healthy control groups and within the ACLR group a strong correlation would exist between all outcome measures and quadriceps strength. Study Design Cross-Sectional Study Methods Twenty-six participants with an ACLR (median 13 months after surgery) and twenty-six matched healthy controls were recruited to participate in this study. Performance was assessed via SLVJ, SLMRH, SLLH, and isokinetic quadriceps strength. Between-group comparisons were made with independent t-tests and Mann-Whitney U test. Within the ACLR group, bivariate correlation and multivariate regression analysis were performed to assess the relationship between the outcome measures and quadriceps strength asymmetry. Results Significant between-limb differences were only identified in the ACLR group (p< 0.05): SLVJ LSI: 88.5%, SLMRH LSI: 93.6%, SLLH LSI: 92.7%, quadriceps strength LSI 80.9% - 83.9%, which were significantly lower (p <0.05) than the healthy control group. Within the ACLR group, a moderate-strong significant (p < 0.05) correlations existed with quadriceps strength and SLVJ (r=0.44-0.65), SLMRH (r =0.43-0.83), and SLLH (r=0.54-0.63); while ACL-RSI had a weak non-significant (p > 0.05) correlation with quadriceps strength (r= 0.12-0.30). Conclusion Single-leg multidirectional test LSIs were less in ACLR participants than matched healthy controls and all were directly related to quadriceps strength. Psychological readiness to return to sport was not related to quadriceps strength. [ABSTRACT FROM AUTHOR]

Background: Revision rates and outcome measures after anterior cruciate ligament reconstruction (ACLR) with suture tape as an internal brace is not well-documented because of the emerging nature of the technique. Hypothesis: ACLR with internal bracing (IB) would lead to decreased revision ACLR compared with traditional ACLR while exhibiting comparable patient outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 200 patients were included in this study. Patients aged between 13 and 39 years at the time of surgery who underwent primary autograft ACLR with IB between 2010 and 2020 and were enrolled in our institution's registry with a minimum of 2-year follow-up were identified and matched 1 to 1 with a non-internal brace (no-IB) group based on concomitant procedures and patient characteristics. Pre- and postoperatively, patients completed the Knee injury and Osteoarthritis Outcome Score, Marx activity rating scale, Veterans RAND 12-Item Health Survey, and visual analog scale for pain. Knee laxity measurements via the KT-1000 arthrometer were included in the pre- and postoperative objective clinical assessments. Results: A total of 100 IB patients were matched with 100 no-IB patients based primarily on concomitant procedures and secondarily on patient characteristics. The IB group underwent significantly fewer revision ACLRs (1% vs 8%; P =.017). Even though the no-IB group had a significantly longer mean final follow-up time (48.6 months [95% CI, 45.4-51.7] vs 33.4 months [95% CI, 30.3-36.5]; P <.001), the time elapsed from the original ACLR to the revision did not differ significantly between groups, and the mean ages for the IB and no-IB groups were comparable (19 vs 19.9 years). All postoperative patient-reported outcome scores between the 2 groups were comparable and significantly improved postoperatively except for the Marx score, which significantly decreased stepwise for both groups postoperatively. KT-1000 measurements significantly improved in both groups after surgery with the IB and no-IB cohorts yielding comparable results at the manual maximum pull (0.97 vs 0.65 mm). Conclusion: ACLR with IB resulted in a significantly decreased risk of revision ACLRs while maintaining comparable patient-reported outcomes. Therefore, incorporating an internal brace into ACLR appears to be safe and effective within these study parameters. [ABSTRACT FROM AUTHOR]

Background: With an increasing number of primary anterior cruciate ligament reconstructions (ACLRs), the burden of revision ACLR (rACLR) has also increased. Graft choice for rACLR is complicated by patient factors and the remaining available graft options. Purpose: To examine the association between graft type at the time of rACLR and the risk of repeat rACLR (rrACLR) in a large US integrated health care system registry while accounting for patient and surgical factors at the time of revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Data from the Kaiser Permanente ACLR registry were used to identify patients who underwent a primary isolated ACLR between 2005 and 2020 and then went on to have rACLR. Graft type used at rACLR, classified as autograft versus allograft, was the exposure of interest. Multivariable Cox proportional hazard regression was used to evaluate the risk of rrACLR, with ipsilateral and contralateral reoperation as secondary outcomes. Models included factors at the time of the rACLR (age, sex, body mass index, smoking status, staged revision, femoral fixation, tibial fixation, femoral tunnel method, lateral meniscal injury, medial meniscal injury, and cartilage injury) and a factor from the primary ACLR (activity at injury) as covariates. Results: A total of 1747 rACLR procedures were included. The crude cumulative rrACLR incidence at 8-year follow-up was 13.9% for allograft and 6.0% for autograft. Cumulative ipsilateral reoperation incidence at 8-year follow-up was 18.3% for allograft and 18.9% for autograft; contralateral reoperation cumulative incidence was 4.3% for allograft and 6.8% for autograft. With adjustment for covariates, a 70% lower risk for rrACLR was observed for autograft compared with allograft (hazard ratio [HR], 0.30; 95% CI, 0.18-0.50; P <.0001). No differences were observed for ipsilateral reoperation (HR, 1.05; 95% CI, 0.73-1.51; P =.78) or contralateral reoperation (HR, 1.33; 95% CI, 0.60-2.97; P =.48). Conclusion: The use of autograft at rACLR was associated with a 70% lower risk of rrACLR compared with allograft in this cohort from the Kaiser Permanente ACLR registry. When accounting for all reoperations outside of rrACLR after rACLR, the authors found no significant difference in risk between autograft and allograft. To minimize the risk of rrACLR, surgeons should consider using autograft for rACLR when possible. [ABSTRACT FROM AUTHOR]

Background: Long-term outcomes for isolated anterior cruciate ligament (ACL) reconstructions in competitive American football athletes are well reported in the literature, but little data currently exist regarding multiligament knee injury (MLKI) reconstruction outcomes., Purpose: To examine patient-reported and return-to-sport outcomes of competitive American football athletes who underwent primary, single-staged, multiligament knee reconstruction., Study Design: Case series; Level of evidence, 4., Methods: We identified patients from our institution's prospectively collected data repository between 2001 and 2020 who underwent single-staged surgical reconstruction of an MLKI sustained during competitive participation in American football. We assessed patient-reported outcomes at a minimum of 2 years after surgery using the International Knee Documentation Committee (IKDC) Subjective Knee Form and questions regarding surgical satisfaction and return to sport. Successful return to sport was defined as a return to preinjury level of competition. We summarized all outcome data and compared outcomes between 2-ligament and >2-ligament groups and between ACL-only MLKI injury and bicruciate MLKI injury groups using independent t test for IKDC scores and chi-square test for return to sport. Additionally, we evaluated predictors of postoperative IKDC scores using linear regression and predictors of return to sport using logistic regression., Results: Outcome data were successfully collected for 53 of 73 total eligible patients (73%; mean follow-up time, 7.7 ± 4.0 years; all male; mean age at surgery, 18.1 ± 2.7 years). The mean postoperative IKDC score was 84 ± 16. The most common level of preinjury competition was high school (n = 36; 68%), followed by college (n = 10; 19%). Seven patients did not return to sport competition at any level due to limitations from their knee surgery, and 82% of patients that attempted to return to preinjury level of sport were able to do so. A total of 50 patients (94%) were satisfied or very satisfied with their surgical outcome. The 2-ligament (n = 39) and >2-ligament (n = 14) groups did not significantly differ in IKDC scores ( P = .96) or proportions with successful return to sport ( P = .77). Similarly, the ACL-MLKI injury (n = 39) and bicruciate MLKI injury (n = 14) groups did not significantly differ in IKDC scores ( P = .89) or proportions with successful return to sport ( P = .77). Age and body mass index were not significantly associated with IKDC scores or successful return to sport at follow-up (all P > .05)., Conclusion: This study may represent the largest cohort of competitive American football athletes evaluated for longitudinal outcomes after multiligament knee reconstruction. Despite the severity of these injuries, we found good knee-related function and that the large majority of athletes who attempted to return to sport were successful. The majority of athletes (94%) were satisfied with their operative treatment., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: E.L.C. has received education payments from Prime Surgical and Zimmer Biomet; consulting fees from Arthrex, DJO, Smith & Nephew, and Zimmer Biomet; nonconsulting fees from Arthrex, Medical Device Business Services, and Smith & Nephew; royalties from Arthrex; and hospitality payments from Encore Medical. M.A.R. has received education payments from Arthrex, Smith & Nephew, and Zimmer Biomet; consulting fees from Zimmer Biomet; and nonconsulting fees from Arthrex. B.A.E. has received consulting fees and royalties from Arthrex. M.K.R. has received grant support from Arthrex; education payments from Arthrex, DJO, Fones Marketing Management, and Smith & Nephew; consulting fees and speaking fees from Arthrex and Zimmer Biomet; and hospitality payments from Linvatec and Prime Surgical. J.R.D. has received consulting fees from Arthrex, Bioventus, DJO, Royal Biologics, and Smith & Nephew; nonconsulting fees from Arthrex; and royalties from Arthrex and In2Bones. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: Surgical and anesthetic techniques have enabled a shift to the ambulatory setting for the majority of patients with anterior cruciate ligament (ACL) tears. While this change likely reflects improvements in acute pain management, little is known about national trends in pediatric perioperative pain management after ACL reconstruction (ACLR). Purpose: To describe recent trends in the United States in perioperative pain management for pediatric ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Pediatric patients (age, ≤18 years) who underwent ACLR with peripheral nerve blocks between January 2008 and December 2017 were identified in the Pediatric Health Information System database. We modeled the use of oral and intravenous analgesic medications over time using Bayesian logistic mixed models. Models were adjusted for patient age, sex, race, primary payer, and treatment setting (ambulatory, observation, or inpatient). Results: The study criteria produced a sample of 18,605 patients. Older children were more likely to receive intravenous acetaminophen, intravenous ketorolac, and oral and intravenous opioids. Younger children were more likely to receive ibuprofen. In our adjusted logistic model, treatment setting was found to be an independent predictor of the utilization of all medications. We found an increase in the overall utilization of oral acetaminophen (adjusted odds ratio [adj OR], 1.14 [95% CI, 1.04-1.23]), intravenous acetaminophen (adj OR, 1.42 [95% CI, 1.22-1.65]), and oral opioids (adj OR, 1.16 [95% CI, 1.06-1.28]) over the study period at a typical hospital. We found significant heterogeneity in medication use across hospitals, with the most heterogeneity in intravenous acetaminophen. Other studied descriptive variables did not appear to predict practices. Conclusion: After adjusting for patient characteristics and treatment settings, pain management strategies varied among hospitals and over time. Patient age and treatment setting predicted practices. Regional anesthesia, opioid medications, and intravenous ketorolac remained the mainstays of treatment, while intravenous acetaminophen emerged in use over the course of the study period. The variability in the pain management of pediatric patients undergoing ACLR suggests that further study is necessary to establish the most effective means of perioperative pain management in these patients. [ABSTRACT FROM AUTHOR]

Background: Athletes display persistent muscle deficits and altered limb-loading mechanics at the time of return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). Purpose: To compare an objective profile of adolescent athletes at RTS after ACLR to matched healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 124 participants; 62 patients who underwent ACLR (15.4 ± 1.7 years) and 62 healthy controls (15.3 ± 1.7 years). Motion capture and force plates were used to capture joint motions during jump landing (JL) and single-limb squat (SLS) tasks. Energy absorption contribution (EAC) was calculated, and repeated-measures analysis of variance was used to assess for EAC differences between groups. Participants completed an International Knee Documentation Committee (IKDC) Subjective Knee Form, and isokinetic quadriceps and hamstring strength testing was performed on each limb. Independent t tests were run to examine age, height, weight, and IKDC scores as well as compare differences between groups for quadriceps and hamstring strength. Results: A significant group × joint interaction was found for JL (P <.001) and SLS (P <.001). For JL, patients who underwent ACLR utilized significantly greater hip (P <.001) and significantly less knee (P <.001) EAC on the surgical limb compared with controls. During SLS, patients who underwent ACLR utilized significantly greater hip (P <.001) and significantly less knee (P <.001) EAC on the surgical limb compared with controls. The ACLR cohort demonstrated lower IKDC scores (P <.001) and significantly lower quadriceps strength on the surgical limb (P <.001) than controls. There were no differences in surgical limb hamstring strength between the ACLR cohort and healthy controls (P =.701). Conclusion: Compared with matched healthy controls, the participants who underwent ACLR in this study demonstrated an inferior objective profile at RTS, consisting of deficits in surgical limb loading, self-reported outcomes, and strength. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. Currently, there is no standardized recommendation for the use of VTE prophylaxis during anterior cruciate ligament (ACL) reconstruction. This study sought to evaluate the current prophylactic practices of fellowship-trained sports medicine orthopaedic surgeons in the United States.Hypothesis: Very few surgeons use perioperative VTE prophylaxis for ACL reconstructive surgery.Study Design: Survey.Methods: Surveys were emailed to the alumni networks of 4 large ACGME-accredited sports medicine fellowship programs. Questions were focused on their current use of chemical and nonchemical VTE prophylaxis.Results: Surveys were completed by 142 surgeons in the United States, yielding a response rate of 32%. Of those who responded, 50.7% stated that they routinely use chemical prophylaxis, with 95.5% of those using aspirin (acetylsalicylic acid [ASA]). There was no standardized dosing protocol, with respondents using ASA 325 mg once (46%) or twice daily (26%) or ASA 81 mg once (18%) or twice (10%) daily. The most common reason for not including chemical prophylaxis within the reconstruction procedure was that it is unnecessary given the low risk of VTE. Physicians also based their prophylaxis regimen more on their own clinical experience than concern for litigation.Conclusion: Half of all sports medicine fellowship-trained surgeons surveyed routinely use chemical VTE prophylaxis after ACL reconstruction, with more than 90% of those using ASA. Of those using ASA, there was no prevailing dosing protocol. For those not using chemical prophylaxis, the most important reason was that it was felt to be unnecessary due to the risks outweighing the benefits. Those who do not regularly use chemical prophylaxis would be willing to, however, if a patient had a personal or family history of clotting disorder or is currently on birth control. Additionally, clinical experience was the primary driver for a current prophylaxis protocol.Clinical Relevance: This survey study evaluating the use of VTE prophylaxis with ACL reconstruction lends clinical insight to the current practice of a large, geographically diverse group of fellowship-trained sports medicine orthopaedic surgeons in the United States. [ABSTRACT FROM AUTHOR]

Background: Knowledge of patient characteristics, surgical fixation, graft choice, outcomes, and concurrent injuries of revision anterior cruciate ligament reconstruction (ACLR) is limited. Purpose: To describe the current cohort of revision ACLR captured by a community registry and the outcomes observed in the registered patients. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision ACLR registered between February 2005 and June 2014, by 200 surgeons in 46 hospitals, were evaluated. The Kaiser Permanente ACLR Registry (KPACLRR) collected data intraoperatively and postoperatively using paper forms, electronic medical records, administrative claims data, and patient-reported outcomes. The KPACLRR cohort was longitudinally followed, and outcomes were prospectively ascertained. Outcomes (ie, revisions, subsequent operative procedures, deep surgical site infections, and deep venous thrombosis) were adjudicated via a chart review. Descriptive statistics were employed. Results: Of 2019 patients who underwent revision ACLR, at a median follow-up of 2.2 years (interquartile range, 1.0-3.8 years), 212 (10.5%) required subsequent operative procedures, and 86 (4.3%) were revised a second time. At the time of revision, 55.1% of the patients had at least 1 concurrent meniscal injury, and 26% of those were repairable. Cartilage injuries were present in 42.0% of patients. Deep surgical site infections occurred in 12 patients (0.6%), deep venous thrombosis occurred in 5 patients (0.3%), and 1 patient (0.1%) had a pulmonary embolism. Conclusion: Revision ACLR can be performed with a low short-term revision rate and relatively few complications. At the time of revision, nearly half of these patients had an irreparable meniscal injury, and slightly less than half had a cartilage injury. A large community-based ACLR registry is useful in informing surgeons of current treatment practices, prevalence of concurrent injuries, and outcomes associated with the procedures, especially infrequent procedures such as revision ACLR. [ABSTRACT FROM AUTHOR]

Management of Anterior Cruciate Ligament Injuries : Evidence-based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of anterior cruciate ligament injurie in both skeletally mature and immature patients. This guideline contains eight recommendations and seven options to assist orthopaedic surgeons and all qualified physicians managing patients with ACL injuries based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)

Purpose: The purpose of this epidemiologic study was to quantify the incidence, expense, and concomitant injuries for anterior cruciate ligament reconstruction (ACLR) procedures in the USA from 2003 to 2011 that required an inpatient stay. It was hypothesized that the relative reported rates of concomitant knee injuries would be greater with the MCL and menisci compared to all other concomitant knee injuries.Methods: The National Inpatient Sample from 2003 to 2011 was retrospectively sampled using ICD-9-CM codes to identify ACLR patients and to extrapolate national averages.Results: Between the years of 2003-2011, an average of 9,037 ± 1,728 inpatient hospitalization included ACLRs, of which 4,252 ± 1,824 were primarily due to the ACLR. Inpatient visits primarily due to ACLR involved an average hospitalization of 1.7 ± 0.2 days and cost $30,118 ± 9,066 per patient. Knee injuries that were commonly reported along with inpatient ACLRs included medial meniscus damage (18.1 %), lateral meniscus damage (16.8 %), collateral ligament repairs (12.3 %), and medial collateral ligament strains (6.9 %). Prevalence of meniscus injuries was consistent across years, but MCL-related injuries increased over time.Conclusions: ACLR-related inpatient hospitalizations account for approximately 7.1 % of the total ACLRs performed annually in the USA. Inpatient ACLR procedures continue to decrease in frequency; however, the mean cost per patient increased. Meniscus and collateral ligament injuries were the most commonly reported concomitant knee injuries. The clinical relevance of this investigation is that it informs, on a large clinical cohort of patients, the current state of incidence and expense for ACLR surgeries in an inpatient setting.Level Of Evidence: Prognostic, retrospective study, Level II. [ABSTRACT FROM AUTHOR]

Background: As the health care system in the United States (US) transitions toward value-based care, there is an increased emphasis on understanding the cost drivers and high-value procedures within orthopaedics. To date, there has been no systematic review of the economic literature on anterior cruciate ligament reconstruction (ACLR). Purpose: To evaluate the overall evidence base for economic studies published on ACLR in the orthopaedic literature. Data available on the economics of ACLR are summarized and cost drivers associated with the procedure are identified. Study Design: Systematic review. Methods: All economic studies (including US-based and non–US-based) published between inception of the MEDLINE database and October 3, 2014, were identified. Given the heterogeneity of the existing evidence base, a qualitative, descriptive approach was used to assess the collective results from the economic studies on ACLR. When applicable, comparisons were made for the following cost-related variables associated with the procedure for economic implications: outpatient versus inpatient surgery (or outpatient vs overnight hospital stay vs >1-night stay); bone–patellar tendon–bone (BPTB) graft versus hamstring (HS) graft source; autograft versus allograft source; staged unilateral ACLR versus bilateral ACLR in a single setting; single- versus double-bundle technique; ACLR versus nonoperative treatment; and other unique comparisons reported in single studies, including computer-assisted navigation surgery (CANS) versus traditional surgery, early versus delayed ACLR, single- versus double-incision technique, and finally the costs of ACLR without comparison of variables. Results: A total of 24 studies were identified and included; of these, 17 included studies were cost identification studies. The remaining 7 studies were cost utility analyses that used economic models to investigate the effect of variables such as the cost of allograft tissue, fixation devices, and physical therapy, the percentage and timing of revision surgery, and the cost of revision surgery. Of the 24 studies, there were 3 studies with level 1 evidence, 8 with level 2 evidence, 6 with level 3 evidence, and 7 with level 4 evidence. The following economic comparisons were demonstrated: (1) ACLR is more cost-effective than nonoperative treatment with rehabilitation only (per 3 cost utility analyses); (2) autograft use had lower total costs than allograft use, with operating room supply costs and allograft costs most significant (per 5 cost identification studies and 1 cost utility analysis); (3) results on hamstring versus BPTB graft source are conflicting (per 2 cost identification studies); (4) there is significant cost reduction with an outpatient versus inpatient setting (per 5 studies using cost identification analyses); (5) bilateral ACLR is more cost efficient than 2 unilateral ACLRs in separate settings (per 2 cost identification studies); (6) there are lower costs with similarly successful outcomes between single- and double-bundle technique (per 3 cost identification studies and 2 cost utility analyses). Conclusion: Results from this review suggest that early single-bundle, single (endoscopic)-incision outpatient ACLR using either BPTB or HS autograft provides the most value. In the setting of bilateral ACL rupture, single-setting bilateral ACLR is more cost-effective than staged unilateral ACLR. Procedures using CANS technology do not yet yield results that are superior to the results of a standard surgical procedure, and CANS has substantially greater costs. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure that is highly successful in restoring knee stability and function. The incidence of early ACLR complications and the risk factors for these complications are not well defined. Purpose: To determine the incidence of 30-day complications and patient and surgical risk factors for complications after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology billing codes. Postoperative complications in the 30-day period after surgery were identified. Potential patient and surgical risk factors for 30-day complications after ACLR were analyzed using univariate and multivariate analyses. Results: A total of 4933 patients were identified. Major complications occurred in 27 patients (0.55%), and minor complications occurred in 43 patients (0.87%), with overall complications occurring in 66 patients (1.34%). The most common complications were symptomatic deep venous thrombosis requiring treatment (n = 27; 0.55%), return to the operating room (n = 18; 0.36%), superficial infections (n = 10; 0.20%), deep infections (n = 7; 0.14%), and pulmonary embolism (n = 6; 0.12%). A single mortality (0.02%) occurred. Multivariate analyses demonstrated that smoking, dyspnea, a history of chronic obstructive pulmonary disease, and recent weight loss were all risk factors for the development of overall complications, although in combination, these factors accounted for only 3% of the variance in the complication rate. Conclusion: ACLR has a low incidence of complications (1.34%) in the early postoperative period, with the most common being symptomatic venous thromboembolic disease requiring treatment, return to the operating room, and infections. Because ACLR is an elective procedure, surgeons should use this information to counsel patients on risks and to guide their decision making about patient selection. [ABSTRACT FROM AUTHOR]

Purpose: (1) Report concomitant cartilage and meniscal injury at the time of anterior cruciate ligament reconstruction (ACLR), (2) evaluate the risk of aseptic revision ACLR during follow-up, and (3) evaluate the risk of aseptic ipsilateral reoperation during follow-up., Methods: Using a United States integrated healthcare system's ACLR registry, patients who underwent primary isolated ACLR were identified (2010-2018). Multivariable Cox proportional-hazards regression was used to evaluate the risk of aseptic revision, with a secondary outcome evaluating ipsilateral aseptic reoperation. Outcomes were evaluated by time from injury to ACLR: acute (< 3 weeks), subacute (3 weeks-3 months), delayed (3-9 months), and chronic (≥ 9 months)., Results: The final sample included 270 acute (< 3 weeks), 5971 subacute (3 weeks-3 months), 5959 delayed (3-9 months), and 3595 chronic (≥ 9 months) ACLR. Medial meniscus [55.4% (1990/3595 chronic) vs 38.9% (105/270 acute)] and chondral injuries [40.0% (1437/3595 chronic) vs 24.8% (67/270 acute)] at the time of ACLR were more common in the chronic versus acute groups. The crude 6-year revision rate was 12.9% for acute ACLR, 7.0% for subacute, 5.1% for delayed, and 4.4% for chronic ACLR; reoperation rates a 6-year follow-up was 15.0% for acute ACLR, 9.6% for subacute, 6.4% for delayed, and 8.1% for chronic ACLR. After adjustment for covariates, acute and subacute ACLR had higher risks for aseptic revision (acute HR 1.70, 95% CI 1.07-2.72, p = 0.026; subacute HR 1.25, 95% CI 1.01-1.55, p = 0.040) and aseptic reoperation (acute HR 2.04, 95% CI 1.43-2.91, p < 0.001; subacute HR 1.31, 95% CI 1.11-1.54, p = 0.002) when compared to chronic ACLR., Conclusions: In this cohort study, while more meniscal and chondral injuries were reported for ACLR performed ≥ 9 months after the date of injury, a lower risk of revision and reoperation was observed following chronic ACLR relative to patients undergoing surgery in acute or subacute fashions., (© 2022. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

Concomitant cruciate and meniscus injuries of the knee are generally associated with acute trauma and commonly treated with surgical intervention. Comorbidities (simultaneous presence of two or more medical conditions) may be acquired from changes in activity levels and lifestyle after an injury and/or treatment. This study aimed to compare differences in comorbidity proportions between surgical and nonsurgical approaches in Military Health System beneficiaries who had concurrent cruciate and meniscus injuries. The retrospective case control design included 36-month data that were analyzed to reflect 12 months prior to injury/surgery and 24 months after injury/surgery. A comparison of differences within and between groups in surgical and nonsurgical approaches was calculated and logistic regression was used to determine if surgery increased or decreased the odds of comorbidities at 24 months. In our sample of 2,438 individuals with concurrent meniscus and cruciate injury, 79.1% ( n  = 1,927) received surgical intervention and 20.9% ( n  = 511) elected for nonoperative management. All comorbidities demonstrated significant within-group differences from pre- to postsurgery for those with a surgical intervention; approximately, half the comorbidities increased (i.e., concussion or traumatic brain injury, insomnia, other sleep disorders, anxiety, posttraumatic stress disorder, and tobacco abuse disorder), whereas the other half decreased (i.e., chronic pain, apnea, cardiovascular disease, metabolic syndrome, mental health other, depression, and substance abuse disorders). The odds of acquiring a comorbid diagnosis after surgery reflected the bivariate comparisons with half increasing and half decreasing in odds. To our knowledge, this is the first study to explore comorbidity changes with a control group for individuals with concurrent meniscus and cruciate injuries., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Orthopaedic registries have shown value in tracking and surveillance of patients, implants, and outcomes associatedwith procedures. No current anterior cruciate ligament reconstruction registry (ACLRR) exists in the United States.Purpose: To describe the current cohort captured by an institutional ACLRR and describe the outcomes observed in the registeredpatients and how findings from the ACLRR are disseminated.Study Design: Cohort study; Level of evidence, 2.Methods: The anterior cruciate ligament reconstructions (ACLRs) registered between February 2005 and September 2011 by 244surgeons in 48 medical centers were evaluated. The ACLRR collected data intra- and postoperatively using paper forms and electronicmedical records. The ACLRR cohort was longitudinally followed and outcomes were prospectively ascertained. Outcomes(ie, revisions, subsequent operations, venous thromboembolism, and surgical site infections) were adjudicated via chart review.Descriptive statistics are used to describe the cohort and Kaplan-Meier curves to evaluate survival.Results: During the study period, 16,192 ACLRs (15,101 primary and 1091 revisions) with a median follow-up of 1.6 years (interquartilerange, 0.7-2.8 years) were registered. Male patients received 64% of both primary and revision ACLRs. The mean age atsurgery was 29.5 years (SD, 11.4 years) for primary and revision reconstructions. Cartilage injuries were noted in 25.2% of primaryand 37.5% of revision ACLRs, and meniscal injuries were identified in 60.8% and 53.2%, respectively. Autografts were used in57.6% of primary ACLRs and 20.9% of revisions. Allografts were used in 42.4% of primaries and 78.8% of revisions. In primaryACLR, the most common femoral and tibial fixation types were interference screws (42.2% and 79.7%, respectively). Fixationtype distribution was nearly identical in primaries and revisions. Of the primary ACLRs, 3.7% had subsequent operations onthe same knee and 1.7% on the contralateral knee. Deep surgical site infection developed in 0.3% of primaries and 0.8% ofrevisions. Symptomatic deep vein thromboses were seen in 0.2% of both primaries and revisions. The overall revision ratewas 1.7%. Lower rates of graft survival were identified in younger patients and those with allografts.Conclusion: Large, community-based ACLRRs are useful in informing participating surgeons of current treatment practices,prevalence of concurrent injuries, and outcomes associated with the procedures. Information from the ACLRR can be used todevelop interactive patient and surgeon tools that can be used to optimize patient care. [ABSTRACT FROM AUTHOR]

The evolution of anterior cruciate ligament (ACL) surgery, seemingly circular at times, informs and provides context for past and current controversies in ACL management. The purpose of this systematic review is to objectively summarize the historical course of ACL reconstruction and repair in the United States over the last 40 years. Femoral tunnel drilling and graft selection have evolved dramatically over the last few decades. An initial focus on restoring ACL anatomy was for a period sacrificed for decreased operative morbidity. However, recent developments in operative techniques aim to restore ACL anatomy while also achieving minimal operative morbidity. Despite this historically iterative process, there remains no perfect choice for the treatment of ACL tears. Continued research on ACL repair, anatomic graft placement, graft choice, and augmentation will help our patients over the next generation., Competing Interests: None declared., (Thieme. All rights reserved.)

Anterior Cruciate Ligament (ACL) injury and ACL reconstruction is common in the United States. However, when compared to the standards of other orthopedics procedures today, ACL reconstruction is NOT predictably successful in restoring patients to their pre-injury state. Only 60-70% of reconstructed patients resume their previous level of activity and many patients experience some degree of osteoarthritis. The reasons for such limitations of success are many. A recent renewal of interest in the many variables affecting ACL reconstruction and the understanding of the varying needs of patients with ACL injury holds promise for improving success even today as well as ultimately providing a normal knee for patients after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate nationwide trends and regional variability in opioid prescriptions after common orthopaedic procedures., Methods: A retrospective analysis of privately insured subjects from the MarketScan database between 2015 and 2016 was conducted. Median oral morphine equivalents and interquartile ranges were analyzed by region for the initial post-op prescriptions and 90-day total prescriptions for opioid-naive patients undergoing the following: carpal tunnel release; anterior cruciate ligament reconstruction; arthroscopic meniscectomy; bimalleolar ankle fracture open reduction and internal fixation; distal radius fracture open reduction and internal fixation; arthroscopic rotator cuff repair; single-level anterior cervical discectomy and fusion; and total shoulder, hip, and knee arthroplasties. We hypothesized that notable regional variability exists with postoperative narcotic prescribing habits., Results: Seventy three thousand nine hundred twenty-one opioid-naive patients were identified. A notable regional variability was observed across the United States in the prescriptions given for all procedures, except total joint arthroplasty. Furthermore, although patients undergoing soft-tissue-only procedures required the fewest refills, patients undergoing total joint arthroplasty required the most., Discussion: Notable regional variability exisits in opioid prescribing patterns for many common orthopaedic procedures. Furthermore, prescriptions were smallest in the region most affected by the opioid epidemic. This information can be used to re-evaluate recommendations, serve as a benchmark for surgeons, and develop institutional and quality improvement guidelines to reduce excess postoperative opioid prescriptions., Level of Evidence: Level III observational cohort study., (Copyright © 2020 by the American Academy of Orthopaedic Surgeons.)

Background: There is a lack of information on anterior cruciate ligament (ACL) reconstruction outcomes and complications for patients with congenital hypocoagulable conditions. The specific aim of this retrospective study was to report operative outcomes and complications for patients with congenital hypocoagulable disorders who underwent ACL reconstruction., Methods: We performed a retrospective review of all patients who underwent an ACL reconstruction within Truven MarketScan Commercial Claims and Encounter Database from 2010 to 2014. Hemophilia A, hemophilia B and patients were identified. Patient demographics, cost of surgery, blood product use, concomitant injuries, repeat ACL injury, complications and various operative variables were collected. Statistical tests were conducted on SAS 9.4 2013., Results: Thirty-three hemophilia A, three hemophilia B, 63 von Willebrand factor patients, and 103,478 controls underwent ACL reconstruction. There is a statistically significant difference for hemarthrosis 1 year leading up to injury for hemophilia A compared with control (P = 0.0083). Total healthcare utilization 90 days after surgery was statistically significant for hemophilia A ($30,310 ± 52,745, P < 0.001) and von Willebrand factor ($20,355 ± 23,570, P < 0.001) compared with control ($14,564 ± 9512). Length of hospital stay, postoperative hemorrhage, concomitant injuries to the knee, additional ACL injury, infection rate, deep-vein thrombosis, and pulmonary embolism were not statistically significant. None of the hemophilia A or von Willebrand factor patients received blood products intraoperatively or postoperatively., Conclusion: Hemophilia A and von Willebrand factor patients had rates of postoperative complications and ACL re-injuries that were not statistically significant. Cost of healthcare utilization was identified as dramatically greater for hemophilia A and von Willebrand factor patients., Competing Interests: Declaration of Competing Interest The authors have no potential conflicts of interest to disclose., (Published by Elsevier B.V.)

Introduction: Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction., Hypothesis: Regional differences in opioid prescribing patterns after ACL reconstruction are present., Study Design: Descriptive epidemiology study., Level of Evidence: Level 4., Methods: The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed., Results: A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription ≥90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription ≥90 MMED and the Northeast had the lowest (12%), P < 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions ≥90 MMED varied significantly by state, P < 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017; P < 0.001). A significant change in the proportion of patients being prescribed ≥90 MMED was also present ( P = 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017)., Conclusion: This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing., Clinical Relevance: Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.

Objective: To determine the incidence of anterior cruciate ligament (ACL) injuries in the National Hockey League (NHL) and to examine the effects of this injury on return-to-play status and performance., Design: Case series; level of evidence, 4., Methods: This was a 2-phase study. Phase I used the NHL electronic injury surveillance system and Athlete Health Management System to collect data on ACL injuries and man games lost over 10 seasons (2006/2007-2015/2016). Data collected in phase I were received in deidentified form. Phase II examined the performance impact of an ACL injury. Players were identified through publically available sources, and performance-related statistics were analyzed. Data collected in phase II were not linked to data collected in phase I. A paired t test was used to determine any difference in the matching variables between controls and cases in the preinjury time period. A General linear model (mixed) was used to determine the performance impact., Results: Phase I: 67 ACL injuries occurred over 10 seasons. The incidence for all players was 0.42/1000 player game hours (forward, 0.61; defenseman, 0.32, goalie, 0.08) and by game exposure was 0.2/1000 player game exposures (forward, 0.33; defenseman, 0.11; goalie, 0.07). Forwards had a greater incidence rate of ACL tears with both game hours and game exposures when compared with defensemen and goalies (P < 0.001, <0.001; P = 0.008, <0.001, respectively). Phase II: 70 ACL tears (60 players) were identified. Compared with controls, players who suffered an ACL tear demonstrated a decrease in goals/season (P < 0.04), goals/game (P < 0.015), points/season (0.007), and points/game (0.001). Number of games and seasons played after an ACL injury did not differ compared with controls (P = 0.068, 0.122, respectively)., Conclusions: Anterior cruciate ligament injuries occur infrequently, as it relates to other hockey injuries. Despite a high return to play, the performance after an ACL injury demonstrated a decrease in points and goals per game and per season.

Purpose: Despite public recognition, obesity is a growing epidemic affecting an estimated 34% of adults and 20% of children in the U.S., Population: As such, the number of ACL reconstructions performed in this population is likely to increase. The goal of this study is to evaluate the risk that increasing BMI poses for additional surgery at the time of ACL reconstruction., Methods: A retrospective analysis of the American College of Surgeons' National Surgical Quality Improvement Program's (ACS-NSQIP) database for the years 2005-2015 was conducted. Logistic regressions were used to assess the relationship between BMI and additional CPT codes for internal derangement at the time of ACL reconstruction. Internal derangement was defined as any CPT code for treatment of a meniscus tear, chondral lesion, or loose body removal. Surgeries for multi-ligamentous knee injuries were excluded., Results: A total of 11,403 patients undergoing ACL reconstruction were identified. 41.9% of patients had an associated CPT code for internal derangement. As BMI increased, there was a corresponding increase in the odds of additional surgery. Specifically, for every 1.0 increase in BMI, the risk of additional surgery increased by 1.6% (p < 0.001). Compared to patients with a BMI of 18.5-24.9, those with a BMI 25-29.9 had an odds ratio (OR) of 1.112, BMI 30-34.9 had an OR of 1.137, BMI 35-39.9 had an OR of 1.249, and those ≥ 40 had an OR of 1.442 for additional surgery (p < 0.001)., Conclusions: This nationally-representative, population-based study demonstrates that patients with elevated BMI are much more likely to require additional surgery in the setting of primary ACL reconstruction. This risk correlates with increasing BMI. Surgeons should keep these risks in mind when evaluating and counseling patients for surgery in the setting of ACL reconstruction., Level of Evidence: Case-control study, Level III.

Background: Treatment of ACL injury is surgical reconstruction. It is not known whether the result is better depending on the type of graft used. Insulin-like growth factor type 1(IGF-1) is a powerful stimulant of extracellular matrix and chondrocyte growth., Material and Methods: Experimental, analytical, prospective, longitudinal study in patients with ACL reconstruction in a period from 2016 to 2017. The concentration of IGF-1 in synovial fluid of these patients operated with allograft and autograft was determined, its association with postoperative evolution was determined. For statistical analysis, two-way ANOVA with Mann-Whitney post-hoc U was used., Results: A significant increase in IGF-1 was identified in the allograft group at 90 days of postopertory. In the autograft group, a significant increase in IGF-1 was observed from 30 days of postoperative. The autograft group was found to have significantly higher levels of IGF-1 (3.27 ± 0.09 ng/ml) compared to the allograft group (2.80 ± 0.11 ng/ml; p 0.001) at 90 days after graft placement., Discussion: IGF-1 levels were higher in patients with autologous graft, knee functionality was clinically similar in both groups at 30 and 90 days.

The future of orthopedic surgery appears to be intimately associated with the development of orthobiologics to facilitate healing and the treatment of multiple disease processes. The orthopedic community should understand developmental processes to ensure that products are adequately studied and the effects are fully known before widespread implementation in the clinical setting. Technologies that embrace this paradigm will impact the field the most., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Abnormal knee mechanics may contribute to early cartilage degeneration following anterior cruciate ligament reconstruction. Anterior cruciate ligament graft geometry has previously been linked to abnormal tibiofemoral kinematics, suggesting this parameter may be important in restoring normative cartilage loading. However, the relationship between graft geometry and cartilage contact is unknown., Methods: Static MR images were collected and segmented for eighteen subjects to obtain bone, cartilage, and anterior cruciate ligament geometries for their reconstructed and contralateral knees. The footprint locations and orientation of the anterior cruciate ligament were calculated. Volumetric, dynamic MR imaging was also performed to measure tibiofemoral kinematics, cartilage contact location, and contact sliding velocity while subjects performed loaded knee flexion-extension. Multiple linear regression was used to determine the relationship between non-anatomic graft geometry and asymmetric knee mechanics., Findings: Non-anatomic graft geometry was related to asymmetric knee mechanics, with the sagittal plane graft angle being the best predictor of asymmetry. A more vertical sagittal graft angle was associated with greater anterior tibial translation (β = 0.11mmdeg, P = 0.049, R 2  = 0.22), internal tibial rotation (β = 0.27degdeg, P = 0.042, R 2  = 0.23), and adduction angle (β = 0.15degdeg, P = 0.013, R 2  = 0.44) at peak knee flexion. A non-anatomic sagittal graft orientation was also linked to asymmetries in tibial contact location and sliding velocity on the medial (β = -4.2mmsdeg, P = 0.002, R 2  = 0.58) and lateral tibial plateaus (β = 5.7mmsdeg, P = 0.006, R 2  = 0.54)., Interpretation: This study provides evidence that non-anatomic graft geometry is linked to asymmetric knee mechanics, suggesting that restoring native anterior cruciate ligament geometry may be important to mitigate the risk of early cartilage degeneration in these patients., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: To determine patient and surgical risk factors for admission after anterior cruciate ligament reconstruction (ACLR) using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database., Methods: All instances of ACLR from 2005 to 2014 from the ACS NSQIP prospective database were analyzed. Both univariate analysis and binary logistic regression were performed to determine which patient demographics and medical comorbidities were associated with admission after surgery., Results: Of the 9,146 patients undergoing ACLR, 1,197 (13.1%) required admission. Univariate analysis found that the following variables were associated with the need for admission: decreased age, Hispanic ethnicity, higher American Society of Anesthesiologists class, higher Charlson Comorbidity Index, use of an epidural anesthesia, longer operative times, prior operation within 30 days, dyspnea, smoking, diabetes, chronic obstructive pulmonary disease, previous cardiac surgery, hypertension, previous revascularization procedure, and a known bleeding disorder. Independent predictors of admission on multivariate analysis included Hispanic ethnicity (odds ratio [OR] 8.9), use of epidural anesthesia (OR 6.3), known bleeding disorder (OR 4.02), increased body mass index (OR 1.03), longer operation time (OR 1.012), and younger age (OR 1.008)., Conclusions: Our study identifies Hispanic ethnicity, use of epidural anesthesia, and history of bleeding disorder as major independent risk factors for admission after ACLR., Level of Evidence: Level III, retrospective comparative study., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: Anterior cruciate ligament (ACL) rupture is increasingly common in adolescents. Time between ACL rupture and surgical reconstruction, surgical wait time, is related to concurrent meniscal tear incidence and possibly tear pattern. This study defines the relationship between meniscal tear characteristics and surgical wait time in adolescents with ACL rupture., Methods: One-hundred and twenty-one consecutive adolescent (median age 16.1 years, range 9-19 years) ACL rupture patients undergoing primary ACL reconstruction were studied. All had documented surgical wait time, preoperative and 6-month post-operative outcome (Lysholm and pedi-IKDC) scores, and intraoperative meniscus tear characteristics. Meniscal tear severity was graded according to the Lawrence and Anderson system: non-surgical: grade 1; reparable: grade 2-3; irreparable: grade 4-5. Significant tears were defined as at least grade 2., Results: Average age at surgery was 16.1 years. 48.7 % had surgical wait time greater than 6 months. 42.5 % of menisci were torn. With surgical wait time <6 months, there were more lateral than medial tears (48 vs 21 %, p = 0.001). With surgical wait time >6 months, medial tear incidence increased (50 vs 21 %, p < 0.001), there were more significant tears (63 vs 42 %, OR 2.3, p = 0.02), and preoperative Lysholm and pedi-IKDC scores were lower (58 vs 74, p < 0.001; 52 vs 61, p < 0.007). Scores were lower in patients with meniscus tears (63.8 vs 69.3, n.s.; 53.9 vs 60.5, p = .04). Patients with public insurance had risks of surgical wait time greater than 3 months (OR 12.4, p < 0.001) and 6 months (OR 7.8, p < 0.001), and of a significant meniscus tear (OR 2.5, p = 0.03). Six-month post-operative pedi-IKDC scores improved more in meniscus tear patients (28.4 vs 21, p = 0.05)., Conclusions: This study shows a significant increase in medial meniscal tear incidence, decrease in preoperative scores, and worse tear severity with surgical wait time >6 months. Public insurance was a risk factor for longer surgical wait time and meniscus tear.

Background: The use of tobacco is a well-established cause of preventable morbidity and mortality. There have been few studies examining the effect of tobacco use on outcomes and complications after arthroscopic knee procedures such as anterior cruciate ligament (ACL) reconstruction., Purpose: To investigate the relationship between tobacco use and rates of postoperative infection, venous thromboembolism (VTE), arthrofibrosis, and subsequent ACL reconstruction after primary ACL reconstruction., Study Design: Cohort study; Level of evidence, 3., Methods: A national insurance database was queried for patients who underwent arthroscopic-assisted ACL reconstruction using Current Procedural Terminology code 29888. Patients underage for tobacco use in all regions of the United States (age <20 years), those with prior ACL reconstruction, and those with the following concomitant procedures were excluded: open cruciate or collateral ligament reconstruction, open or arthroscopic cartilage procedures, patellar stabilization, extra-articular ligamentous reconstruction, and posterior cruciate ligament reconstruction. Tobacco use and non-tobacco use cohorts were queried using International Classification of Diseases-9th Revision coding. The non-tobacco use patients were then matched to the patients with coded tobacco use by age, sex, obesity, diabetes, meniscal repair, and meniscectomy. Complications within 90 days postoperatively were assessed for both cohorts, including infection, VTE, arthrofibrosis, and subsequent ipsilateral or contralateral ACL reconstruction after the index procedure., Results: A total of 13,358 patients who underwent ACL reconstruction met inclusion and exclusion criteria, including 1659 patients with documented tobacco use and 11,699 matched controls. The incidence of infection was significantly higher in patients who use tobacco (2.0%) versus matched controls (0.9%; odds ratio [OR], 2.3; P < .0001). The rate of VTE was also significantly higher in patients who use tobacco (1.0%) compared with matched controls (0.5%; OR, 1.9; P = .035). The rate of subsequent ACL reconstruction was significantly higher in the tobacco use cohort (12.6%) compared with matched controls (7.8%; OR, 1.7; P < .0001). There was no significant difference in the rate of postoperative stiffness after ACL reconstruction between patients who use tobacco (2.0%) and matched controls (2.3%; OR, 0.9; P = .656)., Conclusion: ACL reconstruction in patients who use tobacco is associated with significantly increased rates of infection, VTE, and subsequent ACL reconstruction compared with controls. There was no association between tobacco use and postoperative arthrofibrosis after primary ACL reconstruction., (© 2015 The Author(s).)

Background: A limited number of large multiethnic cohorts of patients undergoing anterior cruciate ligament reconstruction (ACLR) exist; therefore, little is known about racial differences in preoperative and intraoperative characteristics of patients undergoing this procedure., Purpose: To evaluate preoperative patient, surgeon, and hospital characteristics and intraoperative findings associated with various patient races undergoing ACLR., Study Design: Cohort study; Level of evidence, 3., Methods: A cross-sectional study of patients undergoing primary ACLR (performed between January 1, 2008 and September 30, 2012) was conducted. The Kaiser Permanente ACLR Registry was used to identify the cases and variables for the study. The variables of age, sex, time from injury to surgery, body mass index, sport at the time of injury, concomitant injury (menisci, cartilage, other ligament), surgeon training, and surgeon and site volumes were evaluated. Race was categorized into white (reference), Hispanic, Asian, and black. Polychotomous regression models were employed. Odds ratios (ORs) and 95% CIs are provided., Results: A total of 14,278 ACLRs were evaluated; there were 7401 (51.8%) ACLRs performed on white, 3912 (27.4%) on Hispanic, 1894 (13.3%) on Asian, and 1071 (7.5%) on black patients. Men predominated overall as well as in each of the race categories. Compared with white patients, after adjusting for all covariates, Asian (OR, 1.24; 95% CI, 1.10-1.40) and Hispanic (OR, 1.52; 95% CI, 1.39-1.67) patients undergoing ACLR were more likely to be male than female, and black patients were more likely to be female (OR, 0.69; 95% CI, 0.60-0.80). All racial groups tended to undergo ACLR in younger age bands compared with white patients, with black patients having the highest odds of being < 17 years (OR, 2.74; 95% CI, 2.23-3.37) and 17 to 24 years of age (OR, 2.28; 95% CI, 1.94-2.68) compared with being ≥ 25 years. Asian patients were more likely injured playing basketball (OR, 4.31; 95% CI, 3.67-5.06), black patients during football (OR, 3.48; 95% CI, 2.73-4.45) and basketball (OR, 5.52; 95% CI, 4.49-6.78), and Hispanic patients during soccer (OR, 3.09; 95% CI, 2.75-3.48). Hispanic patients had a higher likelihood of having both menisci injured at the time of surgery (OR, 1.31; 95% CI, 1.16-1.49) as well as the lateral meniscus (OR, 1.31; 95% CI, 1.17-1.47). Asian patients had a lower likelihood of cartilage injuries (OR, 0.78; 95% CI, 0.68-0.88). Sports medicine fellowship-trained surgeons were more likely to have operated on black (OR, 1.27; 95% CI, 1.07-1.51) and Hispanic (OR, 1.16; 95% CI, 1.04-1.29) patients., Conclusion: In this large representative sample of patients undergoing ACLR in the United States, 48.2% of the cohort was nonwhite, and racial variations in sex, age, sport at injury, and intraoperative findings at ACLR were identified. Understanding the differences in ACL injury presentation and concomitant injuries by race can be useful in helping tailor the development of an ACL injury prevention program, during the informed consent process, and in the arthroscopic portion of the procedure according to patient race-specific characteristics., (© 2015 The Author(s).)