Patients With Medicaid Insurance Undergoing Anterior Cruciate Ligament Reconstruction have Lower Postoperative International Knee Documentation Committee Scores and are Less Likely to Return to Sport Than Privately Insured Patients

Chava, Neha S.; Fortier, Luc M.; Verma, Neil; Khan, Zeeshan A.; Kerzner, Benjamin; Dasari, Suhas P.; Bedi, Asheesh; Verma, Nikhil N.

doi:10.1016/j.asmr.2022.05.005

Cited by 5 publications

(7 citation statements)

References 32 publications

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“…A patient's Medicare or Medicaid status can play a role in clinical outcomes and is an important factor to consider in future PTOAK studies. 29,30 Finally, the decision was made to exclude patients with high-risk factors for knee OA development, namely obesity and diabetes. This was done to best assess injury-induced knee OA development outside of such strongly influencing contexts, although this likely results in an extremely conservative estimate of the true PTOAK incidence and prevalence in the United States, further emphasizing the need for systems-based interventions to offset the significant rise in PTOAK projected.…”

Section: Discussionmentioning

confidence: 99%

The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022

Bank,

Sanghvi,

Hecht

et al. 2024

J Am Acad Orthop Surg

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Introduction: Posttraumatic osteoarthritis of the knee (PTOAK) is a known sequela of bony and soft-tissue articular knee injuries, although its historically reported prevalence is highly variable with no recent population-based studies. Methods: The TriNetX/US Collaborative Network database was queried to identify adult patients diagnosed with a history of knee trauma using ICD-10-CM coding. Primary outcomes measured were yearly incidence proportion (IP), incidence rate (IR), and prevalence of knee osteoarthritis in the United States from 2000 to 2022. Chi square analyses were conducted to compare outcomes across categorical data. Regression modeling was performed to project PTOAK epidemiology to 2030. Statistical significance was held at P < 0.05 for all analyses. Results: Nine hundred forty-eight thousand eight hundred fifty-three patients meeting criteria were identified. As of 2022, the IP of PTOAK was 5.93%, IR was 2.26 × 10−4 cases/person-day, and prevalence was 21.1%. By strata in 2022, posttraumatic knee OA is most prevalent among the 54 to 59-year-old age group (50.9%), 60 to 64-year-old age group (50.3%), 50 to 54-year-old age group (49.7%), female patients (24.2%), and White patients (23.1%). Regression analyses revealed that the IP, IR, and prevalence of PTOAK have increased exponentially from 2000 to 2022. By 2030, the model predicts that the IP will further increase to 10.7% (95% PI = 9.79% to 11.7%), IR will be 3.79 × 10−4 cases/person-day (95% PI = 3.28 × 10−4 to 4.29 × 10−4), and prevalence of PTOAK in the United States will be 40.6% (95% PI = 39.1% to 42.0%). Discussion: These findings echo earlier, smaller scale studies but reveal an alarming rise in PTOAK prevalence, potentially doubling by 2030. The financial burden of knee OA treatment in the United States is already substantial, costing between $5.7 and $15 billion USD annually. This projected increase in prevalence could further increase healthcare expenditures by $1 to 3 billion by 2030. These results emphasize the need for additional research into factors contributing to PTOAK, evidence-based preventive public health interventions, and the development of multidisciplinary system-based care delivery optimization pathways.

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Section: Discussionmentioning

confidence: 99%

The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022

Bank,

Sanghvi,

Hecht

et al. 2024

J Am Acad Orthop Surg

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“…In 2019, the Multicenter Orthopaedic Outcomes Network (MOON) Group found that patients undergoing ACLR with lower SES reported poorer subjective outcomes and were less active at a 2-year follow-up. 14 More recently, Chava et al 5 reported that patients with Medicaid insurance who underwent ACLR had lower postoperative subjective functional outcomes and were less likely to return to sport. Thus, patients with lower SES experience longer delays to treatment, are at greater risk for an additional knee injury, and have worse postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Greater Area Deprivation and Medicaid Insurance Status on Timing of Care and Rate of Reinjury After Anterior Cruciate Ligament Reconstruction

Cherelstein,

Natal-Albelo,

Kuenze

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Lower socioeconomic status and public insurance lead to a longer delay to surgery and a higher likelihood of concomitant pathology before undergoing anterior cruciate ligament reconstruction (ACLR). However, few studies have examined the influence of community deprivation on ACLR timing and outcomes. Purpose/Hypothesis: The primary aim of this study was to define the effect of the area deprivation index (ADI) and insurance classification on access to orthopaedic care after an ACL rupture, and the secondary aim was to determine whether these variables were associated with a second ACL injury after primary ACLR. It was hypothesized that patients with a greater national ADI percentile and Medicaid insurance would experience longer delays to care and an increased risk of reinjury after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed to evaluate patients undergoing primary ACLR between 2016 and 2019. The national ADI percentile was obtained utilizing the Neighborhood Atlas website. The relationship between national ADI percentile and care characteristics (eg, time to specialized care) was investigated using the Spearman rho correlation coefficient ( r). The association between patient and care characteristics and second ACL injury after the index procedure (ie, graft rerupture or contralateral ACL rupture) was investigated using binary logistic regression. Results: A total of 197 patients met the inclusion criteria. Longer times from injury to surgery ( r = 0.238; P < .001) and from specialized care to surgery ( r = 0.217; P = .002) were associated with a greater national ADI percentile. The second injury group reported significantly greater national ADI ( P = .026) and included a greater percentage of patients with Medicaid insurance (31.3%) compared with the no second injury group. Patients experienced 5.1% greater odds of a second ACL injury for each additional month between evaluation and surgery. Conclusion: Greater national ADI percentile and Medicaid insurance status were associated with adverse ACLR timing and outcomes. Patients with a greater national ADI percentile took significantly longer to obtain surgery after ACL injury. Those who sustained a second ACL injury after ACLR had an overall higher mean national ADI percentile and included a greater proportion of patients with Medicaid compared with those who did not sustain a second ACL injury. Future studies should critically investigate the underlying factors of these associations to reach equity in orthopaedic care.

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“…Given that there is an established association between delay in surgery and concomitant chondral and meniscal injuries, these delays in care may have important clinical consequences. 4,17 One recent retrospective cohort study by Chava et al 7 determined that Medicaid patients had lower International Knee Documentation Committee scores as well as decreased rates of return to play as compared with privately insured patients. Given the nature of the present study, it is impossible to know exactly what may have led to delays in care; however, 1 study by Baraga et al 3 examining this issue in Florida found that system-related factors such as lack of access to specialized care accounted for the majority of care delay.…”

Section: Discussionmentioning

confidence: 99%

Association of Emergency Department Evaluation With Public Insurance Use and Treatment Delays for ACL Injury

Zhu,

Morrissey,

Byrne

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background:Utilization of an emergency department (ED) visit for anterior cruciate ligament (ACL) injury is associated with high cost and diagnostic unreliability.Hypothesis:Patients initially evaluated at an ED for an ACL injury would be more likely to be from a lower income quartile, use public insurance, and experience a delay in treatment.Study Design:Cohort study; Level of evidence, 3.Methods:Patients in the Rhode Island All Payers Claims Database who underwent ACL reconstruction (ACLR) between 2012 and 2021 were identified using the Current Procedure Terminology (CPT) code 29888. Patients were stratified into 2 cohorts based on CPT codes for ED or in-office services within 1 year of ACLR. A chi-square analysis was used to test for differences between cohorts in patient and surgical characteristics. Multivariable linear and logistic regression were used to determine how ED evaluation affected timing and outcome variables.Results:While adjusting for patient and operative characteristics, patients in the ED cohort were more likely to have Medicaid (29% vs 12.5%; P < .001) and be in the lowest income quartile (44.6% vs 32.1%; P < .001). ED visit and Medicaid status were associated with increased time to (1) diagnostic magnetic resonance imaging, adding 7.97 days on average (95% CI, 4.14-11.79 days; P < .001) and 8.40 days (95% CI, 3.44-13.37 days; P = .001), respectively; and (2) surgery, adding 20.30 days (95% CI, 14.10-26.49 days; P < .001) and 12.88 days (95% CI, 5.15-20.60 days; P = .001), respectively. Patients >40 years who were evaluated in the ED were 2.5 times more likely to require subsequent ACLR (odds ratio, 2.50 [95% CI, 1.01-6.21]; P = .049).Conclusion:In this study, patients who visited the ED within 1 year before ACLR were more likely to have a lower income, public insurance, increased time to diagnostic imaging, and increased time to surgery, as well as decreased postoperative physical therapy use and increased subsequent ACLR rates in the 40-49 years age-group.

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Patients With Medicaid Insurance Undergoing Anterior Cruciate Ligament Reconstruction have Lower Postoperative International Knee Documentation Committee Scores and are Less Likely to Return to Sport Than Privately Insured Patients

Cited by 5 publications

References 32 publications

The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022

The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022

The Effect of Greater Area Deprivation and Medicaid Insurance Status on Timing of Care and Rate of Reinjury After Anterior Cruciate Ligament Reconstruction

Association of Emergency Department Evaluation With Public Insurance Use and Treatment Delays for ACL Injury

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