The Child Opportunity Index and Outcomes After Pediatric Anterior Cruciate Ligament Reconstruction.

Yang, Daniel; Orellana, Kevin; Lee, Julianna; Bram, Joshua; Sarkar, Sulagna; Renjilian, Christopher B.; Ganley, Theodore J.

Background: Research at the intersection between social determinants of health (SDOH) and orthopaedics remains an area of active exploration, with recent literature demonstrating significant disparities in a wide array of orthopaedic outcomes in patients with different SDOH. Purpose/Hypothesis: The purpose of this study was to use a validated composite measure of SDOH mapped to census tracts (Child Opportunity Index [COI]) to explore disparities in functional outcomes after anterior cruciate ligament (ACL) reconstruction. It was hypothesized that patients with a lower COI score would have delayed surgical care and worse functional outcomes after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic, surgical, and functional outcomes data were extracted for all patients aged ≤18 years who underwent primary ACL reconstruction at our institution between 2009 and 2019. Strength deficits were calculated, and COI quintile scores were obtained. One-way analysis of variance, the chi-square test, and the Fisher exact test were used to compare variables of interest between the lower 2 quintiles (low group) and the upper 2 quintiles (high group). Results: Of the 1027 patients, 226 (22.0%) were in the low group, while 801 (78.0%) were in the high group. There was a significantly greater time from injury to surgery in the low group than in the high group (98.15 ± 102.65 vs 71.79 ± 101.88 days, respectively; P <.001). The low group had a significantly lower extension-flexion range of motion at 1- and 3-month follow-up (P =.03 and P =.02, respectively) but no difference at 6-month follow-up (P =.27). The low group attended fewer physical therapy visits than the high group (24.82 ± 10.55 vs 37.81 ± 18.07, respectively; P <.001). The low group had significant deficits in quadriceps strength at 3, 6, and 9 months at 180 deg/s (P =.03, P <.001, and P =.01, respectively) and at 6 months at 300 deg/s (P =.002). Conclusion: In this study, we found that the COI was associated with disparities in key clinical outcomes including time to surgery, postoperative range of motion, and postoperative strength.

ANTERIOR cruciate ligament surgery; SOCIAL determinants of health; HEALTH status indicators; ECOLOGY; QUESTIONNAIRES; FISHER exact test; HEALTH insurance; SOCIOECONOMIC factors; TREATMENT effectiveness; FUNCTIONAL status; DESCRIPTIVE statistics; CHI-squared test; LONGITUDINAL method; ODDS ratio; SURGICAL complications; RACE; MUSCLE strength; ONE-way analysis of variance; HEALTH equity; DATA analysis software; CONFIDENCE intervals; TREATMENT delay (Medicine); QUADRICEPS muscle; RANGE of motion of joints; EDUCATIONAL attainment; EVALUATION

Orthopaedic Journal of Sports Medicine, 2024, Vol 12, Issue 9, p1

2325-9671

Academic Journal

10.1177/23259671241248433