Abstract
OBJECTIVES: The aim of this study was to identify patient factors that the likelihood of ACL reconstruction (ACLR) being recommended by orthopaedic surgeons in patients with an ACL injury presenting to a large orthopaedic practice. METHODS: A retrospective audit of electronic medical records from the 2024 year of the investigating surgeons identified participants who presented with an ACL injury and consented to participation in a research database. Data collected included sport of injury, chronicity of injury, age, gender, and initial treatment recommendation from the surgeon. Logistic regression was performed to analyze patient factors contributing to the orthopaedic surgeon making an initial recommendation of ACLR. RESULTS: Over the 12 months 685 participants presented with an ACL injury. Soccer was the most common sport of injury, accounting for 28%, followed by rugby (14%) and netball (11%). The median age at the time of ACL rupture was 26 years. The initial treatment recommendation from the surgeon was ACL reconstruction in 71%, non-operative treatment in 15%, and deferred recommendation pending review in 14%. Of those recommended surgery 81% proceeded to ACLR within 12 months. Of those recommended conservative treatment 26% proceed to ACLR 12 months. On binary multiple logistic regression, the factors associated with an initial recommendation of ACLR were participation in a team ball sport (OR 2.3, 95%CI 1.6-3.5), younger age (age 19-34 OR 3.5, 95% CI 2.4-5.3, age 18 less OR 7.4 (3.9-14.1), and male gender (OR 1.8, 95%CI 1.2-2.6). CONCLUSION: Presenting to an Orthopaedic Surgeon with an ACL injury does not inevitably lead to the recommendation of surgical treatment. Younger age, male gender, and team ball sports participation were all factors that increased the odds of the Orthopaedic surgeon recommending ACL reconstruction. These associations likely reflect the perceived physical demands and desired activity levels of these patient groups.