Socioeconomic Disadvantage Is Associated With Delays in Anterior Cruciate Ligament Reconstruction and Greater Rates of Concomitant Meniscectomies.

Abstract

Purpose: To analyze the association between patients' neighborhood level of socioeconomic disadvantage according to their Area Deprivation Index (ADI) and (1) delays between anterior cruciate ligament (ACL) injury and anterior cruciate ligament reconstruction (ACLR), and (2) concomitant knee injuries at the time of treatment.

Methods: This was a retrospective study of consecutive patients aged 18 years or older who underwent an ACLR at a single academic institution between 2015 and 2021. Each patient's home address was mapped to obtain their ADI to determine their level of socioeconomic disadvantage. Patients were categorized by their ADI score into 3 groups: least disadvantaged (ADI scores 0-3), middle group (ADI scores 4-6), and most disadvantaged (ADI scores 7-10). Time-to-event multivariable Cox proportional-hazard analysis was used to assess the association between ADI groups and delays in ACLR while controlling for relevant demographic, clinical, and surgical variables. Additional multivariable logistic regression analyses assessed this relationship using clinically relevant time thresholds of 12 weeks and 6 months between the time of injury and ACLR.

Results: We identified 383 patients for inclusion. Patients in the most disadvantaged group had an increased incidence of concomitant meniscectomies performed at the time of ACLR for irreparable tears (51.5% vs 34.8% [least disadvantaged], P = .04). Multivariate analysis revealed patients in the most disadvantaged group were at significant risk of delayed ACLR (hazard ratio, 1.36; 95% confidence interval [CI], 1.02-1.86; P = .04), with a 2.24 times risk of delays >12 weeks (95% CI, 1.13-4.44, P = .02), and a 2.36 times risk of delays >6 months (95% CI, 1.2-4.65, P = .01). Non-White race was similarly associated with significant risk of ACLR delays >3 (odds ratio, 2.02; 95% CI, 1.22-3.33; P = .006) and 6 months (OR, 1.77; 95% CI, 1.06-2.95; P = .03).

Conclusions: Socioeconomically disadvantaged and non-White patients who sustain ACL tears are at a greater risk of delays in the time of injury to ACLR and for undergoing a concomitant meniscectomy.

Level of evidence: Level IV, retrospective case series.