Summary

Lower Socioeconomic Status Adversely Affects Timing of Care and Rate of Re-Injury Following Anterior Cruciate Ligament Reconstruction

Abstract

Title

Lower Socioeconomic Status Adversely Affects Timing of Care and Rate of Re-Injury Following Anterior Cruciate Ligament Reconstruction

Introduction

Neighborhood socioeconomic status affects patient reported outcomes after ACL reconstruction. Furthermore, multiple studies have reported that time between initial injury and surgery vary greatly in diverse patient populations, irrespective of the health care system in which treatment was provided. Treatment for ACL injuries in a delayed manner has shown to increase additional knee pathology and result in worse long-term prognosis.

Objective

The primary aim of this study was to define the impact of socioeconomic factors, such as national area of deprivation index (ADI) and medical insurance type, on the access to orthopaedic care after an ACL rupture. The secondary aim was to determine if these variables, national ADI and medical insurance, were associated with second ACL injury after primary ACLR. We hypothesized that patients with a greater national deprivation index and Medicaid insurance will have less access to specialized care and an increased risk of re-injury.

Methods

An IRB approved retrospective study was conducted evaluating 339 patients that underwent ACL reconstructions between November 2015 and August 2018 by 3 sports medicine fellowship-trained orthopaedic surgeons. Patients undergoing primary ACL reconstruction were included. Demographic and surgical characteristics data were obtained via chart review and telephone interviews. National ADI percentile was obtained utilizing the Neighborhood Atlas Website and the patients’ home addresses. The relationship between national ADI percentile and care characteristics (e.g., time to specialized care) were investigated using Spearman’s rank correlation coefficients while the association between patient and care characteristics, and second ACL injury were investigated using multivariable logistic regression.

Results

A total of 339 patients met inclusion criteria and had complete datasets for all variables of interest. Participants had an average age of 23 +- 7.4 yrs. 55.8% of the patients were males and identified themselves as: White 45.7%, African American 14.5%, Asian 11.8%, Hispanic 7.7% and Other 21.3%. Patients with a greater national ADI percentage took longer to seek specialized care from time of injury (Spearman’s rank correlation coefficient = 0.141, p = 0.009) as well as to undergo surgery from time of injury (Spearman’s rank correlation coefficient = 0.183, p < 0.001). Individuals who utilized Medicaid insurance had significantly greater odds of experiencing a second ACL injury (OR = 3.079, p = 0.023) when compared to individuals who utilized commercial insurance. National ADI percentile (p = 0.208), time from injury to specialized care (p = 0.342), and time from specialized care to surgery (p = 0.051) did not significantly contribute to the model.

Conclusion

Lower socioeconomic status adversely affects timing of care and re-injury rates following an ACL injury. Patients with a greater national ADI percentage took significantly longer to seek specialized care and obtain surgery following ACL injury. Patients utilizing Medicaid insurance were more likely to sustain a re-injury following ACL Reconstruction. Future studies should look at factors that impede access to care and adversely affect post-operative outcomes.