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Surgical Volume of ACL Reconstruction, Knee Arthroscopy, and Rotator Cuff Repair Before and After the COVID-19 Pandemic: National Surgical Quality Improvement Program Data from 2015 to 2022

Year: 2026

Type: article

Abstract: Background: The COVID-19 pandemic significantly disrupted elective orthopaedic sports procedures, including anterior cruciate ligament (ACL) reconstructions, meniscal surgeries, and rotator cuff repairs. These disruptions also extended into athletics, likely resulting in reduced injury rates in athletes leading to decreased surgical volumes. Hypothesis: It was hypothesized that the COVID-19 pandemic led to an initial decline in ACL reconstructions, meniscal surgeries, and rotator cuff repairs, with a gradual recovery in surgical volumes during the later pandemic years. Study Design: Descriptive epidemiology study. Methods: A retrospective analysis of the American College of Surgeons’ National Surgical Quality Improvement Program database was conducted from 2015 to 2022. Patients undergoing ACL reconstruction, knee meniscectomy or repair, knee foreign body removal, and rotator cuff repair were identified using Current Procedural Terminology codes. Surgical volumes and demographics from 2015 to 2019 served as a baseline for comparison with 2020 to 2022 data. Primary outcome was surgical volume change; secondary outcomes included patient demographics and operative-related factors. Chi-square tests were used for categorical variables and Student t tests for numerical variables, with nonparametric corrections and substitutions as needed. Significance was set at P < .05. Results: Overall, a total of 200,511 cases (N = 200,511 patients) were identified in our database search. From 2019 to 2020, surgical volume decreased by 25.48%, followed by a 10.32% rebound in 2021 and a 2.17% decrease in 2022. All 2022 volume remained below 2019 levels, except for knee meniscal repair. Postpandemic data showed a 5.66% increase in diabetic patients ( P < .001), 14.64% increase in total operative time ( P < .001), 71.43% increase in pneumonia incidence ( P = .02), and 48.48% increase in inpatient surgeries ( P < .001). There was a 21.38% decrease in current smokers ( P < .001) and 5.12% decrease in patients with insulin-dependent diabetes ( P < .001). No change in hospital length of stay was observed ( P = .52). Conclusion: The study showed that orthopaedic sports surgery volumes declined in 2020 because of the COVID-19 pandemic and had not fully returned to prepandemic levels by 2022. Surgeries postpandemic were more commonly inpatient, required longer operative times, and involved patients with shifting demographic and comorbidity profiles. Understanding and reporting changes in surgical volume, setting, and patient profiles postpandemic may better prepare surgeons and health care institutions for future resource disruptions or impaired elective surgical capabilities.

Source: Orthopaedic Journal of Sports Medicine

DOI: 10.1177/23259671251403156