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Comparison of Community-Based ACL Reconstruction Registries in the U.S. and Norway
Gregory B. Maletis, MD1; Lars-Petter Granan, MD, PhD2; Maria C.S. Inacio, MS3; Tadashi T. Funahashi, MD4; Lars Engebretsen, MD, PhD5
1 Department of Orthopedic Surgery, Kaiser Permanente Baldwin Park, Southern California Permanente Medical Group, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706
2 The Norwegian Cruciate Ligament Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendaisbakken 11, N-5021, Bergen, Norway
3 Department of Surgical Outcomes and Analysis, Kaiser Permanente, 3033 Bunker Hill Street, San Diego, CA 92109. E-mail address: maria.cs.inacio@kp.org
4 Department of Orthopedic Surgery, Kaiser Permanente Orange County, Southern California Permanente Medical Group, 6670 Alton Parkway, Irvine, CA 92618
5 Department of Orthopaedics, Oslo University Hospital, 0407, Oslo, Norway
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Department of Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, and the Norwegian Cruciate Ligament Register, Bergen, Norway

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Dec 21;93(Supplement 3):31-36. doi: 10.2106/JBJS.K.00905
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Joint registries have demonstrated value as a resource for the study of large numbers of patients, providing the opportunity to study rare occurrences and identify early failures of surgical procedures. Anterior cruciate ligament (ACL) reconstruction registries have been established in Norway and the U.S. In this study, we compared the preoperative characteristics of the Norwegian National Knee Ligament Registry (NKLR) and the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry (KP ACLRR) cohorts.


A cross-sectional comparison of the NKLR and KP ACLRR cohorts registered between 2005 and 2010 was performed. Aggregate level data including preoperative patient characteristics, mechanisms of injury, preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS), intraoperative findings, and adjusted revision rates were shared between the two registries, and a descriptive analysis was conducted.


During the study period, 10,468 primary ACL reconstructions were entered in the NKLR and 10,394, in the KP ACLRR. The age at the time of surgery was similar between the two cohorts (twenty-seven years in the NKLR versus twenty-eight years in the KP ACLRR), although the KP ACLRR had a higher proportion of males (65% versus 58%, p < 0.001). The revision rate per follow-up year was 0.9% in the NKLR and 1.5% in the KP ACLRR. Soccer was the most common mechanism of injury in both registries (40.0% in the NKLR and 26.6% in the KP ACLRR). The preoperative KOOS was statistically different, but the difference was not clinically relevant (defined as a change of >10 points). A higher prevalence of meniscal tears was seen in the KP ACLRR (61% versus 49%, p < 0.001).


Baseline findings are so congruent between the NKLR and the KP ACLRR cohorts that comparisons between these two registries will likely provide information to the orthopaedic community that can be generalized.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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