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Original research
Epidemiology of cruciate ligament reconstruction in the Australian Defence Force and predictors of outcome
  1. Olivia Williams1,
  2. V R Ross2,
  3. C L Lau1,3 and
  4. H J Mayfield3
  1. 1Research School of Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
  2. 2Health Policy, Programs and Assurance Branch, Joint Health Command, Canberra, Australian Capital Territory, Australia
  3. 3School of Public Health, The University of Queensland Faculty of Medicine and Biomedical Sciences, Herston, Queensland, Australia
  1. Correspondence to Dr Olivia Williams, Research School of Population Health, Australian National University College of Health and Medicine, Canberra, ACT 2601, Australia; o.williams1{at}gmail.com

Abstract

Background The ability to predict the risk of poor outcome following knee cruciate ligament reconstruction in the Australian Defence Force (ADF) population would help direct individual rehabilitation programmes and workforce planning. This study describes the epidemiology of cruciate ligament reconstruction in the ADF and demonstrates the use of Bayesian networks (BN) to predict the likelihood of fitness for ongoing service under different scenarios.

Methods Members who had knee cruciate ligament reconstruction through ADF were identified from billing data and matched to electronic medical records to extract demographic and clinical data. Outcome measure was medical fitness for ADF service up to 24 months after reconstruction. BN models were used to compare outcomes between (1) age groups according to military service, and (2) sexes according to body mass index (BMI).

Results From November 2012 to June 2019, a total of 1199 individuals had knee cruciate ligament reconstruction (average 169 reconstructions/year). Following reconstruction and rehabilitation, 89 (7.4%) were medically unfit for service. Scenario analysis using a tree-augmented naïve BN model showed that, compared with Navy and Air Force, Army members had a higher probability of being unfit in those aged <35 years and a lower probability in those aged ≥35 years. In both sexes, those with obese BMI had the greatest probability of being unfit.

Conclusion While most ADF members were fit for ongoing military service following cruciate ligament reconstruction, service type, age, sex and BMI influenced outcome. BNs provided an interactive and intuitive method to demonstrate the impact of different variables on the outcome.

  • knee
  • epidemiology
  • rehabilitation medicine

Data availability statement

Data may be obtained from a third party and are not publicly available. Data stored with Joint Health Command, Australian Defence Force.

http://dx.doi.org/10.1136/military-2022-002150

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data stored with Joint Health Command, Australian Defence Force.

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    Footnotes

    • Contributors OW, VRR and CLL contributed to design of the study. OW analysed the data and drafted the manuscript. HJM directed the construction of Bayesian networks and performed all Bayesian network model performance analysis. Manuscript review and revisions were made by all authors. The final manuscript was approved by all authors. OW acts as guarantor for the overall content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests OW: This project was completed as part of a Master of Philosophy (Applied Epidemiology) and while receiving a scholarship. CLL was supported by an Australian National Health and Medical Research Council (NHMRC) Fellowship (APP1193826).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.