Influence of Health Insurance Status on the Timing of Surgery and Treatment of Bucket-Handle Meniscus Tears

Sood, Amit; Gonzalez-Lomas, Guillem; Gehrmann, Robin M.

doi:10.1177/2325967115584883

Cited by 31 publications

(30 citation statements)

References 27 publications

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“…Patients with Medicaid insurance were found to have significantly increased lag times from initial dislocation to initial office consultation and surgery. These findings are similar to those previously reported for patients with anterior cruciate ligament and meniscal injuries, where Baraga et al 2 and other studies 8,21,23,30 have described delays in both diagnosis and surgical treatment of patients without private insurance. It is not known whether the patients in this study who experienced significant delays between their first instability event and evaluation at our institution attempted to obtain care elsewhere during this interval and, if so, whether they were successful in doing so.…”

Section: Discussionsupporting

confidence: 91%

“…Previous authors have found that insurance coverage affects timeliness of care for patients with anterior cruciate ligament injuries and meniscal tears, noting that patients with private insurance undergo surgery more expeditiously than those without. 2,21,30 In 2015, 9.1% of all Americans were uninsured and 19.6% had Medicaid. 3 With a limited number of providers accepting Medicaid, patients enrolled in Medicaid as well as those without insurance may have difficulty obtaining office visits and scheduling elective surgery.…”

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confidence: 99%

“…3 With a limited number of providers accepting Medicaid, patients enrolled in Medicaid as well as those without insurance may have difficulty obtaining office visits and scheduling elective surgery. 2,5,8,11,21,23,30,36 The impact of insurance coverage on access to care for patients with traumatic anterior shoulder instability has not been previously investigated.…”

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confidence: 99%

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Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

Williams

Mancini

Kia

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Patients with public insurance often face barriers to obtaining prompt orthopaedic care. For patients with recurrent traumatic anterior shoulder instability, delayed care may be associated with increasing bone loss and subsequently more extensive surgical procedures. Purpose/Hypothesis: The purpose of this study was to evaluate whether differences exist in patients undergoing treatment for shoulder instability between those with Medicaid versus non-Medicaid insurance. We hypothesized that at the time of surgery, Medicaid patients would have experienced greater delays in care, would have a more extensive history of instability, would have more bone loss, and would require more extensive surgical procedures than other patients. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent surgical stabilization for traumatic anterior shoulder instability between January 1, 2011, and December 1, 2015, at a single sports medicine practice. Clinic, billing, and operative records were reviewed for each patient to determine age, sex, insurance type, total number of instability episodes, time from first instability episode to surgery, intraoperative findings, and procedure performed. Glenoid bone loss was quantified by use of preoperative imaging studies. Results: During this time period, 206 patients (55 Medicaid, 131 private insurance, 11 Tricare, 9 workers’ compensation) underwent surgical stabilization for traumatic anterior shoulder instability. Average wait time from initial injury to surgery was 1640 days (95% CI, 1155-2125 days) for Medicaid patients compared with 1237 days (95% CI, 834-1639 days) for others ( P = .005). Medicaid patients were more likely to have sustained 5 or more instability events at the time of surgery (OR, 3.3; 95% CI, 1.64-6.69; P = .001), had a higher risk of having 15% or more glenoid bone loss on preoperative imaging (OR, 3.5; 95% CI, 1.3-10.0; P = .01), and had a higher risk of requiring Latarjet or other open stabilization procedures as opposed to an arthroscopic repair (OR, 3.0; 95% CI, 1.5-6.2; P = .002) when compared with other patients. Conclusion: Among patients undergoing surgery for traumatic anterior shoulder instability, patients with Medicaid had significantly more delayed care. Correspondingly, they reported a more extensive history of instability, were more likely to have severe bone loss, and required more invasive stabilization procedures.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

mentioning

confidence: 99%

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Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

Williams

Mancini

Kia

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…8 Few case reports or clinical studies with limited cohort sizes of repair of bucket-handle meniscus tears exist in the literature, and limited studies clearly define the patient demographics and compare preoperative or intraoperative surgical variables in those with successful repair or failed repair. 4,[9][10][11][12][13][14] The purpose of this study was to evaluate a single academic institution's cohort of patients with buckethandle meniscus tears who underwent arthroscopic repair. Specifically, we sought to (1) report patient demographic information for those who sustained bucket-handle meniscus tears; (2) evaluate patient clinical outcomes, return to sport, complications, and reoperation/revision rates after arthroscopic repair of bucket-handle meniscus tears; and (3) to compare the subgroups of patients with successful outcomes to those with failure after repair in order to identify any correlative patient-related, surgical techniquerelated, or pathology-related factors.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases

et al. 2018

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Objective To define patient demographics, preoperative, and intraoperative surgical variables associated with successful or failed repair of bucket-handle meniscal tears. Design All patients who underwent arthroscopic repair of a bucket-handle meniscus tear at a single institution between May 2011 and July 2016 with minimum 6-month follow-up were retrospectively identified. Patient demographic, preoperative (including imaging), and operative variables were collected and evaluated. A Kaplan-Meier curve was generated to demonstrate meniscus repair survivorship. Results In total, 75 patients (78 knees) with an average age of 26.53 ± 10.67 years met inclusion criteria. The average follow-up was 23.41 ± 16.43 months. Fifteen knees (19.2%) suffered re-tear of the repaired meniscus at an average 12.24 ± 9.50 months postoperatively. Survival analysis demonstrated 93.6% survival at 6 months, 84.6% survival at 1 year, 78.4% survival at 2 years, and 69.9% survival at 3 years. There was significant improvement from baseline to time of final follow-up in all patient-reported outcome ( P < 0.05) except Marx score ( P = 0.933) and SF-12 Mental Subscale ( P = 0.807). The absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively was the only variable significantly associated with repair failure ( P = 0.024). Concurrent anterior cruciate ligament reconstruction (vs. no concurrent anterior cruciate ligament reconstruction) trended toward significance ( P = 0.059) as a factor associated with successful repair. Conclusions With the exception of the absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively, no other variables were significantly associated with re-tear. The results are relatively durable with 84.6% survival at 1 year. Surgeons should attempt meniscal repair when presented with a bucket-handle tear.

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“…23,25 Surgical treatment before the onset of progressive disease and meniscal degeneration decreases the likelihood of unfavorable subjective outcomes and radiographically detectable osteoarthritis. 1,12,13,22 Although a specific timeline of repair has not been established, Sood et al 21 demonstrated that patients with traumatic bucket-handle meniscal tears had a greater rate of successful repair when surgery was performed within 6 weeks of the injury.…”

mentioning

confidence: 99%

Impact of Insurance Status on Time to Evaluation and Treatment of Meniscal Tears in Children, Adolescents, and College-Aged Patients in the United States

Johnson

Nguyen

Shah

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: The meniscus is vital for load bearing, knee stabilization, and shock absorption, making a meniscal tear a well-recognized sport-related injury in children and young adults. An inverse relationship between the quality and value of orthopaedic care provided and the overall treatment cycle exists in which delayed meniscal tear treatment increases the likelihood of unfavorable outcomes. Although a majority of children and young adults have health insurance, many athletes within this demographic still face significant barriers in accessing orthopaedic services because of insurance type and household income. Purpose: To determine the impact of insurance status and socioeconomic markers on the time to orthopaedic evaluation and treatment as well as the rate of surgical interventions for meniscal tears in children and young adult athletes in the United States. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of all patients ≤22 years of age who presented to our institution between 2008 and 2016 and who were diagnosed with meniscal tears. Patients were categorized based on insurance and socioeconomic status. Dates of injury, referral, evaluation by an orthopaedic surgeon, and surgery were also recorded. Chi-square and regression analyses were utilized to determine the significance and correlation between the influencing factors and time to referral, evaluation, and surgery. Results: Publicly insured, commercially insured, and uninsured patients comprised 49.4%, 26.6%, and 24.1%, respectively, of the 237 patients included in this study. Insurance status was predictive of time to orthopaedic referral, initial evaluation, and surgery ( P < .01). Uninsured and publicly insured patients experienced significant delays during their orthopaedic care compared with commercially insured patients. However, no correlation was found between insurance status or household income and the rate of surgical interventions. Conclusion: Publicly insured and uninsured pediatric and college-aged patients faced significant barriers in accessing orthopaedic services, as demonstrated by substantially longer times between the initial injury and referral to an orthopaedic evaluation and surgery; however, these socioeconomic factors did not affect the rate of surgical management. Clinical competency regarding the effects of socioeconomic factors on the time to orthopaedic care and efforts to expedite care among underinsured and underserved children are vital for improving patient outcomes.

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Influence of Health Insurance Status on the Timing of Surgery and Treatment of Bucket-Handle Meniscus Tears

Cited by 31 publications

References 27 publications

Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases

Impact of Insurance Status on Time to Evaluation and Treatment of Meniscal Tears in Children, Adolescents, and College-Aged Patients in the United States

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