Abstract
Background:
Few studies have investigated the primary patient demographic factors affecting outcomes following anterior cruciate ligament reconstruction (ACLR) in pediatric and adolescent populations. We sought to identify whether public insurance and participation in high-risk sports are associated with subsequent graft tear or all-cause repeat surgery following ACLR.
Hypothesis:
We hypothesize that patients with public insurance type, those participating in high-risk sports, and those with greater socioeconomic disadvantage would have greater rates of graft tears and all-cause repeat surgery.
Methods:
The charts of 166 pediatric and adolescent patients (age <22) undergoing arthroscopic ACLR with bone-tendon-bone (BTB) (n=116), or quadriceps (n=50) autografts between 2011 and 2023 at a large academic institution in California were retrospectively analyzed. Demographic data was collected, and chi-squared analysis as well as multivariate logistical regression was conducted with a p-value of <0.05 used to determine statistical significance.
Results:
Chi-squared analysis revealed that race/ethnicity was significantly associated with both graft tear and all-cause repeat surgery outcomes (p= 0.0000125) (p=0.01), respectively. Black patients had significantly higher rates of repeat surgery following ACLR compared to White patients (21.74% vs 4.65%, p=0.016), and the highest rate of graft tear with borderline statistical significance (17.39%, p=0.053). There was no statistically significant association between age (p=1, p=1), gender (p=0.13, p=0.12), graft type (p=0.67, p=0.06), insurance status (p=0.20, p=0.12), area deprivation index (ADI) (p=1, p=0.89), participation in high-risk sport (p=0.1, p=1) or location of physical therapy (p=0.08, p=0.19) with either subsequent graft tear following ACLR or all-cause repeat surgery, respectively. Additionally, compliance with physical therapy was significantly associated with subsequent graft tear (p=0.04) but not repeat surgery (p=0.44). Multivariate logistic regression revealed Black patients (p=0.006) and patients who received BTB autografts (p = 0.010) had significantly increased odds of graft tear following ACLR.
Conclusion:
Black pediatric patients have higher rates of graft tear following ACLR. The effect of race could partially be mediated by lower PT compliance rates as a result of structural barriers and medical mistrust. Future studies should further investigate the ideal graft choice in pediatric populations as well as potential barriers in pediatric racial minorities’ postoperative ACLR treatment.