Public Interest in Anterior Cruciate Ligament Reconstruction, Repair, and Bridge-Enhanced Repair: A 20-Year Time-Series Analysis.
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- Also identified by DOI 10.1016/j.jisako.2026.101178.
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Abstract
Public interest in anterior cruciate ligament (ACL) surgery has evolved with the emergence of repair techniques and technologies such as the bridge-enhanced ACL repair (BEAR) implant. Therefore, the purpose of this study was to evaluate 20-year trends in public interest in ACL reconstruction, ACL repair, and BEAR implant and to assess temporal changes, academic-public coupling, and projected future search behavior. Google Trends was queried for "ACL reconstruction," "ACL repair," "BEAR implant," and "internal brace ACL" from January 2004 through March 2026 (US and worldwide). Monthly relative search volume (RSV) was extracted. Compound annual growth rates (CAGR) and era comparisons (2014-2018 vs 2019-present) were calculated. Interrupted time-series analysis assessed level and slope changes at four prespecified milestones, including COVID-19 disruption, BEAR FDA De Novo clearance, and BEAR randomized controlled trial publication. Spearman correlation evaluated associations between annual PubMed publication counts and RSV. Pre-whitened cross-correlation assessed temporal relationships between terms. Autoregressive models forecasted trends through December 2028. "ACL reconstruction" had the highest mean RSV (US, 29.9) but a declining CAGR of -1.7%/year (95% CI: -2.0%, -1.4%). "ACL repair" and "BEAR implant" showed positive growth of +4.7% (95% CI: 3.4%, 5.9%) and +14.1% (95% CI: 12.9%, 15.4%) per year. ITS analysis at BEAR FDA De Novo clearance (December 2020) showed statistically significant post-milestone slope acceleration for "ACL repair" (+0.23 RSV/mo, p<0.001); "BEAR implant" did not accelerate beyond its pre-existing trend. Exploratory ARIMA forecasts suggest "ACL repair" RSV may approach "ACL reconstruction" levels by 2028. Over 20 years, public search interest has shifted from ACL reconstruction toward repair-oriented approaches. As these queries continue to rise, surgeons should anticipate more patient inquiries on ACL repair and augmentation, necessitating proactive clinical awareness and evidence-based resources to guide shared decision-making. IV; Retrospective Infodemiologic Time-Series Analysis.