ACL Tears in School-Aged Children and Adolescents Over 20 Years.
Level 3 - non-randomized controlled study
Retrospective population-based insurance claims cohort study
PubMed 28228501 · doi:10.1542/peds.2016-1877
What was done
Retrospective descriptive epidemiological study examining insurance billing records from 1994 to 2013 for patients aged 6 to 18 years. Cases were identified using CPT and ICD-9-CM codes for ACL tears and reconstructions. Injury rates were normalized to person-years enrolled in the database and stratified by sex and age groups (6–14, 15–16, and 17–18 years).
What was found
ACL tear incidence averaged 121 ± 19 per 100,000 person-years (range 92–151), with an overall annual increase of 2.3%. Rates increased significantly over time in all subgroups except males aged 6–14 and 17–18 years. Females had a significantly higher incidence overall compared to males, except in the 17–18 age category. Peak incidence occurred at age 16 for females (392 per 100,000 person-years) and age 17 for males (422 per 100,000 person-years).
Why it matters
This study documents a 20-year upward trend in pediatric and adolescent ACL injuries and identifies high school ages (16–17 years) as the peak window of vulnerability for targeted prevention programs.
Limits
The total number of patients included is not stated in the abstract. Findings rely on administrative coding data, which carries risks of coding inaccuracy or misclassification. The dataset reflects an insured cohort and does not measure athletic exposure hours, sport-specific participation, or changes in diagnostic imaging practices over time.
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