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Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017
  1. Simon G F Abram1,
  2. Andrew J Price1,
  3. Andrew Judge1,2,
  4. David J Beard1
  1. 1 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  2. 2 Musculoskeletal Research Unit, University of Bristol, Bristol, UK
  1. Correspondence to Simon G F Abram, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; simon.abram{at}


Objectives We investigated the temporal trend and the geographical variation in the rate of an anterior cruciate ligament (ACL) reconstruction and meniscal repair (MR) performed in England during a 20-year window.

Methods All hospital episodes for patients undergoing ACL reconstruction or MR between 1 April 1997 and 31 March 2017 were extracted by procedure code from the national hospital episode statistics. Age-standardised and sex-standardised rates of surgery were calculated using Office for National Statistics population data as the denominator and analysed over time both nationally and regionally by National Health Service clinical commissioning group (CCG).

Results Between 1997–1998 and 2016–2017, there were 133 270 cases of ACL reconstruction (124 489 patients) and 42 651 cases of MR (41 120 patients) (isolated or simultaneous). Nationally, the rate of ACL reconstruction increased 12-fold from 2.0/100K population (95% CI 1.9 to 2.1) in 1997–1998 to 24.2/100K (95% CI 23.8 to 24.6) in 2016–2017. The rate of MR increased more than twofold from 3.0/100K (95% CI 2.8 to 3.1) in 1997–1998 to 7.3/100K (95% CI 7.1 to 7.5) in 2016–2017. Of these cases, the rate of simultaneous ACL reconstruction and MR was 2.6/100K (95% CI 2.5 to 2.8) in 2016/2017. In 2016–2017, for patients aged 20–29, the sex-standardised rate of ACL reconstruction was 76.9/100K (95% CI 74.9 to 78.9) and for MR was 19.8/100K (95% CI 18.8 to 20.9). Practice varied by region—in 2016–2017, 14.5% (30/207) of the CCGs performed more than twice the national average rate of ACL reconstruction and 15.0% (31/207) performed more than twice the national average rate of MR.

Conclusions The rate of ACL reconstruction (12-fold) and MR (2.4-fold) has increased in England over the last two decades. There is variation in these rates across geographical regions and further work is required to deliver standardised treatment guidance for appropriate use.

  • knee
  • arthroscopy
  • meniscus
  • anterior cruciate ligament
  • ACL

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  • Contributors SGFA: concept, methodology, analysis, writing and editing paper, guarantor. AJP: concept, methodology, editing paper. AJ: methodology, analysis, editing paper. DJB: concept, methodology, editing paper.

  • Funding This report is independent research supported by the National Institute for Health Research (NIHR Doctoral Research Fellowship, SGFA, DRF-2017-10-030) and NIHR Oxford Biomedical Research Centre (BRC). AJ is supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.

  • Competing interests AJ has received consultancy fees from Freshfields Bruckhaus Deringer (on behalf of Smith & Nephew Orthopaedics), and is a member of the data safety and monitoring board (which involved receipt of fees) from Anthera Pharmaceuticals.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.