Nationwide Trends in Arthroscopic Knee Surgery and ACL Reconstruction in Romania, 2017–2023: Insights from a Seven-Year Health System Analysis

Arthroscopic knee surgery represents a cornerstone of modern orthopedic practice, yet nationwide data from Eastern Europe remain scarce. This study provides the first comprehensive assessment of arthroscopic knee procedures in Romania over a seven-year period (2017-2023), focusing on anterior cruciate ligament (ACL) reconstruction trends and related interventions. Using national hospital discharge data, all arthroscopic knee procedures were identified and analyzed by year, sex, age group, region, and hospital type. A total of 76,804 procedures were recorded, including 26,888 reconstructions (O15301/O15303) and 29,979 meniscectomies (O13404). ACL reconstructions increased from 1560 cases in 2017 (7.9/100,000 inhabitants) to 1865 in 2023 (9.8/100 k), with a marked decline in 2020 (5.3/100 k) due to the COVID-19 pandemic and full recovery thereafter. Men predominated in ACL reconstructions (74%; 8226 males vs. 2854 females), whereas meniscectomy peaked in middle-aged adults (50-54 years: 48.7/100 k). Surgical activity was highly centralized, with five counties performing over two-thirds of all ACL reconstructions. Approximately 89% of procedures were conducted in public hospitals. These findings reveal substantial progress but also persistent regional and demographic inequities. Strengthening access, standardizing indications for degenerative meniscal surgery, and establishing a national ACL registry could support equitable, evidence-based advancement of arthroscopic care in Romania.