The rate of anterior cruciate ligament reconstruction in Australia is high: a national registry is needed

John W Orchard, Lars Engebretsen and Julian A Feller
Med J Aust 2018; 208 (8): . || doi: 10.5694/mja18.00095
Published online: 7 May 2018

Supporting a registry is an investment in the long term health of our nation

This issue of the MJA includes the results of an important study that again indicate the high rate of anterior cruciate ligament (ACL) reconstruction in Australia.1 It was already known that Australia has relatively high rates of knee ACL injuries, surgical reconstruction,2,3 and knee replacement (arthroplasty).4 The new data highlight worrying increases in the rates of both primary and revision ACL reconstruction, particularly in adolescents.1 Many factors could potentially explain an increase in the rate of ACL surgery, including more accurate diagnosis, greater access to surgery, and more people playing sport (factors that would be pleasing), but also an increase in the rate of ACL injuries per exposure (which would be disappointing). It is harder to envisage a positive explanation for an increase in the revision ACL reconstruction rate, but it is important to differentiate between contributors to failure, particularly between surgical factors (ie, techniques associated with a higher failure rate) and rehabilitation factors, such as returning to sport before adequate functional recovery has been achieved.5,6

  • 1 University of Sydney, Sydney, NSW
  • 2 University of Oslo, Oslo, Norway
  • 3 OrthoSport Victoria, Melbourne, VIC


Competing interests:

No relevant disclosures.

  • 1. Zbrojkiewicz D, Vertullo C, Grayson JE. Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Med J Aust 2018; 208: 354-358.
  • 2. Janssen KW, Orchard JW, Driscoll TR, et al. High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008: time for an anterior cruciate ligament register by Scandinavian model? Scand J Med Sci Sports 2012; 22: 495-501.
  • 3. Lekkas C, Clarnette R, Graves SE, et al. Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Knee Surg Sports Traumatol Arthrosc 2017; 25: 1510-1516.
  • 4. Pabinger C, Lothaller H, Geissler A. Utilization rates of knee-arthroplasty in OECD countries. Osteoarthritis Cartilage 2015; 23: 1664-1673.
  • 5. Nagelli CV, Hewett TE. Should return to sport be delayed until 2 years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Med 2017; 47: 221-232.
  • 6. Grindem H, Snyder-Mackler L, Moksnes H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 2016; 50: 804-808.
  • 7. Granan LP, Forssblad M, Lind M, et al. The Scandinavian ACL registries 2004-2007: baseline epidemiology. Acta Orthop 2009; 80: 563-567.
  • 8. Magnussen RA, Trojani C, Granan LP, et al. Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2339-2348.
  • 9. Maletis GB, Granan LP, Inacio MC, et al. Comparison of community-based ACL reconstruction registries in the US and Norway. J Bone Joint Surg Am 2011; 93 Suppl 3: 31-36.
  • 10. Havelin L, Espehaug B, Vollset S, et al. The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg Am 1995; 77: 1543-1550.
  • 11. Kolling C, Simmen B, Labek G, et al. Key factors for a successful National Arthroplasty Register. J Bone Joint Surg Br 2007; 89: 1567-1573.
  • 12. Gianotti S, Marshall S, Hume P, et al. Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 2009; 12: 622-627.
  • 13. Moses B, Orchard J, Orchard J. Systematic review: annual incidence of ACL injury and surgery in various populations. Res Sports Med 2012; 20: 157-179.
  • 14. Ardern CL, Ekås G, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Knee Surg Sports Traumatol Arthrosc 2018; doi:10.1136/bjsports-2018-099060. [Epub ahead of print].
  • 15. Khan T, Alvand A, Prieto-Alhambra D, et al. ACL and meniscal injuries increase the risk of primary total knee replacement for osteoarthritis: a matched case-control study using the Clinical Practice Research Datalink (CPRD). Br J Sports Med 2018; doi:10.1136/bjsports-2017-097762. [Epub ahead of print].
  • 16. Taylor JB, Waxman JP, Richter SJ, et al. Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis. Br J Sports Med 2015; 49: 79-87.
  • 17. Orchard J, Chivers I, Aldous D, et al. Ryegrass is associated with fewer non-contact anterior cruciate ligament injuries than bermudagrass. Br J Sports Med 2005; 39: 704-709.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.