Trends in arthroscopic meniscus and anterior cruciate ligament surgery in Japan: Review of a 3-year registry of the Japan Sports Orthopaedic Association.

Abstract

Arthroscopic techniques for the knee joint continue to evolve, driven by the global shift toward "save the meniscus" and refinement of anterior cruciate ligament reconstruction technique. The purpose of this study was to evaluate nationwide trends in meniscal surgery and anterior cruciate ligament reconstruction in Japan using three years of data from the Japan Sports Orthopaedic Association registry. This registry-based study analyzed arthroscopic knee procedures performed by Japan Sports Orthopaedic Association member surgeons between April 2021 and March 2024. Extracted data included isolated medial and lateral meniscus procedures, repair techniques, primary and revision anterior cruciate ligament reconstructions, graft selection, and concomitant meniscal treatments. There were 51,074, 52,681, and 54,841 arthroscopic knee surgeries in 2021, 2022, and 2023, respectively. Medial meniscal repair increased annually (37.6%-41.9%), and lateral meniscal repair exceeded resection across all years. Arthroscopic meniscus resection decreased both in medial and lateral meniscus resections over time. The all-inside with anchor device technique was common in medial (43.2%-49.9%) and lateral (37.3%-48.9%) meniscus repairs. The inside-out, outside-in, intra-articular all-inside, and pull-out techniques were also frequently performed. Primary anterior cruciate ligament reconstructions increased from 12,114 to 13,500 cases, with hamstring autografts predominant (>80%), but decreased slightly over time. Quadriceps tendon autografts increased from 1.5% to 3.8%. The number of revision anterior cruciate ligament reconstruction cases was 1,072, 1,669, and 1,084, respectively. Bone-patellar tendon-bone autografts were the most commonly (∼60%) used for revision anterior cruciate ligament reconstructions. Hamstring autografts decreased from 33.6% to 28.4%, with quadriceps tendon graft use increasing from 8.3% to 11.6%. This study provides the first nationwide analysis of arthroscopic knee surgery focusing on meniscus and anterior cruciate ligament procedures in Japan, demonstrating increasing adoption of meniscal repair and changing graft selection patterns in anterior cruciate ligament reconstruction.