Chondral Injuries and Irreparable Meniscal Tears Among Adolescents With Anterior Cruciate Ligament or Meniscal Tears Are More Common in Patients With Public Insurance

Williams, Ariel A.; Mancini, Nickolas; Solomito, Matthew J.; Nissen, Carl W.; Milewski, Matthew D.

doi:10.1177/0363546517707196

Cited by 36 publications

(56 citation statements)

References 14 publications

(39 reference statements)

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“…Although male sex and revision surgery were most strongly associated with both BCLs and glenoid bone loss, patient race, specifically black race, was also independently associated with BCLs and glenoid bone loss involving >10% of the glenoid width, which is a novel finding worth noting. Although several nonmodifiable patient demographic and social factors have been shown to influence access to care for similar sports medicine procedures routinely performed in young, active patients, 27,30,43 further study of this particular finding in patients with shoulder instability is warranted.…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Glenohumeral Bone and Cartilage Lesions at the Time of Anterior Shoulder Stabilization Surgery: A Comparison of Patients Undergoing Primary and Revision Surgery

et al. 2018

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Section: Discussionmentioning

confidence: 99%

The Incidence of Glenohumeral Bone and Cartilage Lesions at the Time of Anterior Shoulder Stabilization Surgery: A Comparison of Patients Undergoing Primary and Revision Surgery

et al. 2018

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“…This finding aligns with previous studies that have found similar associations between health insurance type and prevalence of additional knee injuries. [5,21]…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic status impacts outcomes following pediatric anterior cruciate ligament reconstruction

et al. 2019

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Previous research has shown that delays in pediatric anterior cruciate ligament (ACL) reconstruction are associated with increased prevalence of concomitant knee injuries and worse outcomes following surgery. However, few studies have described factors that may contribute to these delays and adverse outcomes. This study seeks to determine the effect of socioeconomic status on clinical outcomes following ACL reconstruction.A retrospective review of patients who underwent primary ACL reconstruction at a tertiary pediatric hospital between 2009 and 2015 was conducted. Variables included chronologic, demographic, and socioeconomic data, and postoperative complications. Socioeconomic status was measured using health insurance type and median household income levels derived from 2009 to 2015 US Census Bureau.A total of 127 patients (69 male, 58 female) were included. The mean age at time of surgery was 15.0 years. Overall, 68 patients had commercial insurance and 59 patients had government-assisted insurance. The mean household median income for patients with commercial insurance was $87,767 compared to $51,366 for patients with government-assisted insurance. Patients with government-assisted insurance plans demonstrated greater delays in time from injury to initial orthopaedic evaluation (P = .0003), injury to magnetic resonance imaging (MRI) examination (P = .021), injury to surgery (P < .0001), initial orthopaedic evaluation to surgery (P = .0036), and injury to return to play clearance, P = .044. Median household income was significantly related to time from injury to MRI examination (P = .0018), injury to surgery (P = .0017), and initial orthopaedic evaluation to surgery (P = .039). Intraoperatively, 81% of patients with government-assisted insurance had concomitant meniscal injuries compared 65% of patients with commercial insurance, P = .036. Postoperatively, 22% of patients with government-assisted insurance were found to have decreased knee range of motion (“stiffness”) compared to 9% of patients with commercial insurance, P = .034.Pediatric patients who have government-assisted plans may experience delays in receiving definitive injury management and be at risk for postoperative complications. Our findings suggest a significant discrepancy in time to treatment as well as rates of concomitant knee injuries and postoperative complications between government and commercial insurance types.Level of Evidence: III

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“…In the United States, a recent study reported that 14% of patients undergoing ACL reconstruction had Medicare, Medicaid, or other government-sponsored insurance, which is an almost 3-fold increase from 5% in 1996. 3 We hypothesized that government-sponsored health care would put patients at an increased risk of MUA/LOA, as numerous studies have reported a decrease or lag in access to care for this patient population, 2 , 16 , 24 and because we have noticed from our own experience that it is often more difficult for these patients to access physical therapy both preoperatively and postoperatively. The results of this study do not support this hypothesis, as the relative risk for undergoing MUA/LOA after ACL reconstruction for patients enrolled in government-sponsored health care was not found to be statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Manipulation Under Anesthesia and/or Lysis of Adhesions After Anterior Cruciate Ligament Reconstruction

Huleatt

Gottschalk

Fraser

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:In the currently published literature, a higher risk for developing arthrofibrosis after anterior cruciate ligament (ACL) reconstruction has been reported for female patients, adolescents, early surgery or concomitant procedures, and the use of a patellar tendon autograft. There is a lack of evidence regarding other graft choices or factors.Hypothesis:Multiple risk factors will play a significant role in the development of arthrofibrosis after ACL reconstruction. Specifically, we hypothesized that the risk of manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA) would be affected by graft choice and patient demographic factors.Study Design:Case-control study; Level of evidence, 3.Methods:The charts of all patients who underwent ACL reconstruction over a 10-year period at a single academic institution were queried from an electronic medical record database and reviewed at a minimum of 6 months after ACL reconstruction, with the collection of demographic and surgical data. The relative risk for undergoing MUA and/or LOA was calculated for each analyzed risk factor.Results:A total of 2424 ACL reconstructions were included, with a chart review at a mean of 56.7 months after surgery (range, 7.6-124.0 months). The rate of MUA and/or LOA for arthrofibrosis was 4.5%. A statistically significantly increased relative risk was found for infection (5.45), hematoma requiring evacuation (3.55), ACL reconstruction with meniscal repair (2.83), use of a quadriceps tendon autograft (2.68), age <18 years (2.39), multiple concomitant procedures (1.69), contact injury (1.62), female sex (1.60), and surgery within 28 days of injury (1.53), and a statistically significantly decreased relative risk was found for revision ACL reconstruction (0.30), age >25 years (0.34), and use of a tibialis anterior allograft (0.36). In the multivariate regression model, the use of a quadriceps tendon autograft (P = .00007), infection (P = .00126), and concomitant meniscal repair (P = .00194) were independent risk factors, whereas revision ACL reconstruction (P = .0024) was an independent protective factor.Conclusion:Graft type, infection, concomitant meniscal repair, and primary reconstruction are significant risk factors for undergoing MUA or LOA after ACL reconstruction.

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Chondral Injuries and Irreparable Meniscal Tears Among Adolescents With Anterior Cruciate Ligament or Meniscal Tears Are More Common in Patients With Public Insurance

Cited by 36 publications

References 14 publications

The Incidence of Glenohumeral Bone and Cartilage Lesions at the Time of Anterior Shoulder Stabilization Surgery: A Comparison of Patients Undergoing Primary and Revision Surgery

The Incidence of Glenohumeral Bone and Cartilage Lesions at the Time of Anterior Shoulder Stabilization Surgery: A Comparison of Patients Undergoing Primary and Revision Surgery

Socioeconomic status impacts outcomes following pediatric anterior cruciate ligament reconstruction

Risk Factors for Manipulation Under Anesthesia and/or Lysis of Adhesions After Anterior Cruciate Ligament Reconstruction

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