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The purpose of this study is to identify predictors of disparities in patient-reported outcome measures (PROMs) before and after arthroscopic meniscectomy. Knee injury and Osteoarthritis Outcome Score (KOOS) was used in this study. All patients who underwent single-knee arthroscopic meniscectomy from January 2012 to March 2018 performed by a single surgeon at an academic safety-net hospital were identified. We excluded patients who had undergone ipsilateral previous knee surgery, bilateral meniscectomy, or concomitant ligament, cartilage, or osteotomy procedures, and those with severe radiographic osteoarthritis in the operated knee, missing preoperative data, or military insurance. Data abstracted from medical records included demographics (age, sex, race, insurance type), clinical characteristics (body mass index, Charlson comorbidity index, and Kellgren-Lawrence [KL] grade), procedure codes, and KOOS assessed before and 90 days after surgery. Multivariable analyses investigated the associations between patient characteristics and the KOOS Pain, other Symptoms, and Function in activities of daily living (ADL) subscales. Among 251 eligible patients, most were female (65.5%), half were of nonwhite race (50.2%), and almost one third were insured by Medicaid (28.6%). Medicaid and black race were statistically significant (p < 0.05) predictors of worse preoperative values for all three KOOS subscales. Medicaid insurance also predicted a lower likelihood of successful surgery, defined as meeting the 10-point minimal clinically important difference, for the KOOS symptoms (p < 0.05) and KOOS ADL (p < 0.05) subscales. Compared with patients without definitive evidence of radiographic osteoarthrosis (KL grade 1), those with moderate radiographic osteoarthritis (KL grade 3) were less likely to have a successful surgical outcome (p < 0.05 for all subscales). Worse preoperative KOOS values predicted worse postoperative KOOS values (p < 0.001 for all subscales) and a lower likelihood of surgical success (p < 0.01 for all subscales). Insurance-based disparities in access to orthopaedic care for meniscus tears may explain worse preoperative PROMs and lower success rates of meniscectomy among Medicaid patients. Patients with meniscus tears and radiological and/or magnetic resonance imaging evidence of osteoarthritis should be carefully evaluated to determine the appropriateness of arthroscopic meniscectomy.

IntroductionFemoral torsion is an important anatomical consideration of the hip that has major implications on the natural motion of the hip joint. Similarly, it affects pathologic conditions of the hip, including femoroacetabular impingement, dysplasia, and/or microinstability. Femoral torsion is typically measured on two-dimensional (2D) axial CT cuts by creating the angle between the femoral neck and the posterior aspect of the ipsilateral femoral condyles. Position of the leg during imaging may affect 2D measurements. Threedimensional (3D) analysis of a hip CT with inclusion of femoral alignment may portray the anatomy of the hip more accurately as compared to a 2D slice-based analysis of a hip CT scan. It is thought that femoral torsion measured using this system could be a more accurate and reliable means of measurement. The primary purpose of this study is to assess the differences in measuring femoral torsion with 3D modeling and analysis compared to the standard 2D slice-based approach on a CT scan. Secondarily, we attempt to determine how the passive range of motion of the hip correlates with femoral torsion measured using the 3D model versus the 2D model. MethodsIn a prospective cohort study of 20 patients, femoral torsion was assessed using both 2D analysis and 3D analysis. The differences between these measurements on each of the imaging modalities were compared. Additionally, each patient had the passive range of motion of their hip measured with a goniometer. The amount of internal and external rotation was measured with the hip in a neutral position and with the hip flexed to 90°. Acetabular version, combined version, and alpha angle were added to multivariate regression analysis to evaluate their effect versus femoral torsion alone. ResultsFemoral antetorsion measured using the standard 2D slice-based approach on CT scan was 22.1° (SD: 11.1°), which was higher (p<0.001) than that using 3D analysis (8.25°; SD: 10.5°). There was a strong correlation between femoral torsion measurements using 3D analysis and 2D analysis (R=0.91). Based on 3D analysis, there was a moderate correlation between femoral torsion and passive hip external rotation measured with the hip flexed to 90° (R=0.65, p<0.002) and with the hip in a neutral position (R=0.58, p<0.007). ConclusionThere was a significant difference between femoral torsion measurements using the 3D analysis, which showed approximately 14° of less antetorsion on average. Additionally, rotation of the hip and femoral torsion was correlated to higher levels of antetorsion associated with more internal rotation of the hip.