Anterior Cruciate Ligament Reconstruction in Brazil: National Trends, Regional Disparities, and Healthcare Burden

Abstract To evaluate temporal trends, regional disparities, healthcare burden, and patterns of anterior cruciate ligament (ACL) reconstruction procedure utilization within the Brazilian Unified Health System (SUS) between 2008 and 2025. This is a retrospective nationwide ecological time-series study using secondary administrative data obtained from the Hospital Information System of the Brazilian Unified Health System (DATASUS/SIH/SUS). All ACL reconstruction procedures performed between 2008 and 2025 were identified. Procedure volume, population-adjusted rates, regional distribution, healthcare expenditures, length of hospital stay, and in-hospital mortality were analyzed. An exploratory analysis comparing observed procedure volume with international estimates of ACL injury incidence was also performed. A total of 139,385 ACL reconstruction procedures were performed during the study period. Annual volume increased from 4,954 procedures in 2008 to 13,155 in 2025, representing a 165.6% increase. Population-adjusted rates rose from 2.61 to 6.16 procedures per 100,000 inhabitants. The Southeast region accounted for 46.6% of all procedures, followed by the South (21.4%) and Northeast (17.7%). Total healthcare expenditures reached R$ 457.3 million. Mean length of hospital stay decreased from 2.36 to 1.38 days, while only six in-hospital deaths were recorded. Based on international incidence estimates, observed procedure volume represented 5.8–9.1% of the expected ACL injury burden and 14.4–22.7% of the estimated surgical demand. ACL reconstruction procedures increased substantially within the SUS between 2008 and 2025; however, marked regional disparities persisted. Population-adjusted analyses demonstrated substantial variation in procedure utilization across Brazilian regions and states. Exploratory comparisons with international epidemiological estimates suggest a discrepancy between expected ACL injury burden and observed procedure volume, warranting further investigation into potential factors influencing access to specialized orthopedic care in Brazil. Level IV, retrospective ecological time-series study based on a nationwide administrative database.