Trends in Pediatric Anterior Cruciate Ligament Reconstruction: The Effect of COVID-19

Context: The number of pediatric anterior cruciate ligament reconstructions (ACLRs) occurring yearly increased almost 6- fold from 2004-2014. We find it interesting that limited recent data exist on rates of ACL injury and reconstruction in children and adolescents, especially in the context of COVID-19. Objective: Given the effect of the COVID-19 pandemic on youth sports seasons and the postponement of many elective surgeries, we sought to examine the changes in rates of ACLR during this period. Design: Retrospective cohort study. Setting: This study used the Pediatric Health Information System (PHIS) database to identify eligible patients at PHISparticipating hospitals nationwide from January 2016-June 2021, with March 1, 2020, considered the start of the COVID- 19 pandemic. Patients or Other Participants: Using Current Procedural Terminology codes, patients 18 years old and younger who underwent ACLR surgery were identified. Main Outcome Measure(s): Patient demographics and overall rates of surgery prepandemic and intrapandemic were compared. Data were analyzed using bivariate, mixed-model, and time series analyses. Results: A total of 24 843 ACLRs were identified during this time period. In total, 1853 fewer surgeries than expected were performed after March 2020 given prepandemic trends. Intrapandemic demographics revealed an increase in the proportion of patients who identified as White and with private insurance and a decrease in the proportion who identified as Black and with public insurance. Also, the proportion of ACLRs by region shifted, with more surgeries performed in the Midwest and fewer in the Northeast. In the model adjusted for hospital-level variability, only race and insurance status remained significant. Conclusions: Based on prepandemic trends, fewer patients than projected underwent ACLR once the pandemic began, likely due to a combination of decreased rates of injury and delayed surgery.