In 1999, a landmark study1 reported that women were more likely than men to sustain an anterior cruciate ligament (ACL) injury in sex-comparable collegiate sports. Since then, an extensive body of research has focused on understanding and addressing sex disparities in ACL injuries.2,3 This study aimed to investigate time trends in ACL reconstruction among commercially insured individuals in the United States while focusing on sex differences among adolescents with the goal of assessing the effectiveness of the intensive research and prevention efforts of the past 15 years in reducing the sex disparity in ACL injury incidence.
Data were analyzed from the 2002 through 2014 Truven Health Analytics MarketScan Commercial Claims and Encounters database, which contains health care use information for approximately 148 million privately insured individuals younger than 65 years. Anterior cruciate ligament reconstruction was identified by Current Procedural Terminology codes (29888, 27428) and International Classification of Diseases, Ninth Revision (ICD-9) procedure codes (81.45), and annual rates were calculated within age (<13, 13-17, 18-30, 31-40, and >40 years) and sex strata. The denominator for each year consisted of the total number of person-months of continuous enrollment in that year for all individuals in the database. This study was determined to be exempt by the University of North Carolina at Chapel Hill institutional review board, and patient consent was not required as this study involved existing data.