While cost is readily assumed to be a significant barrier to accessing healthcare, this may only be one of many factors that delay patients from seeking early treatment following musculoskeletal injuries. The primary aim of this study was to further define the impact of socioeconomic factors on the access to and utilization of orthopaedic care after an anterior cruciate ligament (ACL) rupture. The secondary goal was to determine if these variables were associated with preoperative instability events and bucket handle tears of the meniscus discovered at the time of surgery.
All patients undergoing ACL reconstruction at our institution from October 2015 through November 2018 were surveyed to determine income, primary language, education level and preoperative instability episodes. A chart review was then performed for insurance status, dates of injury, first visit with orthopaedics, date of surgery, intraoperative pathology, and length of follow-up. Multivariate regression analysis was utilized to select independent predictors of outcome variables. A multiple linear regression model with stepwise backward elimination was used for continuous outcome variables. Multivariate logistic analysis was used for the presence of a bucket handle meniscal tear at the time of surgery. P<0.05 was considered significant.
After application of inclusion criteria, 230 patients were included with a mean±SD age of 26.5±9.9 years. Insurance status, dates of injury, first visit with orthopaedics, date of surgery, intraoperative pathology and length of follow-up were thus available for these patients. 126 of these patients responded to the survey regarding income, primary language, education level and preoperative instability episodes. Patients with government insurance saw an orthopaedic surgeon 39.4 weeks later (P=0.012) and had surgery 5 weeks later than those with private insurance (P=.016). English speakers saw an orthopaedic surgeon 55.7 weeks earlier than Spanish speakers (P=0.027) and had an average of 0.8 less instability episodes before surgery (P<0.001). Non-English speakers had an increased risk of having a bucket handle tear at the time of surgery (OR=4.62; 95CI%=1.7677-21.33). Patients with an income greater than $100,000/year had 0.325 less instability episodes before surgery (P=.040). Patients with a college degree saw a surgeon 36.0±SD weeks earlier than patients without a college degree (P=0.023). Patients with an annual household income less than $100,000 were more likely to have a bucket handle tear (OR=7.4; 95CI%=1.2-53.4).
Insurance status, primary language spoken, education and income impacted the access to and utilization of orthopaedic care after an ACL rupture, which may affect preoperative instability events and concomitant injuries such as bucket handle tears of the meniscus at the time of ACL reconstruction.