Sports medicine as a specialty started as knee reconstruction on football
players. Today, sports medicine operations typically entail arthroscopically
performed, minimally invasive operations on joints and their ligaments.
Oftentimes these operations include multiple procedures performed
together, most notably knee meniscus repair and ACL reconstruction.
Therefore, the number of procedures is greater than the number of
operations. Because the focus of this book is upon the impact of the
implant revolution, and because I am driving toward an overall number of
patients in America who have a device implanted in their bodies in a given
year, combined procedures are counted as a single operation. This
complicates an already daunting task of calculating the reach of the device
industry, particularly in orthopedic sports medicine. No one truly knows
the precise figure, but by cross-checking multiple sources, like industry
reports, medical literature publications, insurance databases, and state and
federal agency databases, the numbers get more reliable.
ACL reconstruction stabilizes the knee, and is typically performed on
non-Medicare patients in an outpatient setting. Recent studies show a
significant increase in the rate of ACL surgery over the last fifteen years.
In 1994, the rate of surgery was 33 per 100,000 capita,^24 increasing to 40.9
cases in 2004,^25 and further increasing to 45.1 per 100,000 capita in
2006.^26 That ten-year-old data equates to 134,421 ACL reconstruction
operations per year. The US Census Bureau estimates that there were
318,646,275 people in America on July 4, 2014,^27 which I will use to
calculate numbers of procedures in this book. Even if the rate of 45.1 per
100,00 capita did not increase (unlikely), a total of 143,689 ACL
reconstructions were estimated to have been performed in 2014. However,
that number is a vast underestimate if compared to the market analysis
performed by those “in the know.” In 2016, there were 493,328 knee
ligament reconstructions (including 34,005 multi-ligament reconstruction
operations).^28 With a compound annual growth rate of 3.93 percent in
knee ligament repair, an extrapolated number of 455,600 knee ligament
reconstructions were performed in 2014, triple the number that would have
been predicted from the medical literature a decade earlier.
There are over half a million knee arthroscopic operations per year in
which a portion, or all, of the knee meniscus is removed. In 2014, there
were 416,400 knee meniscus repair operations and 2,200 meniscus