Bodendorfer, Blake, MD

Chang, Edward, MD

Conroy, Christine

Curley, Andrew, MD

Fryar, Caroline, MS

Hopkins, Mark, MD

McCormick, Brian

Wang, David

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works USF-LVHN SELECT Lower Socioeconomic Status Adversely Affects Timing of Care and Rate of Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Injury Caroline Fryar MS Andrew Curley MD David Wang Christine Conroy Brian McCormick See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/select-program  Part of the Medical Education Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Authors Caroline Fryar MS, Andrew Curley MD, David Wang, Christine Conroy, Brian McCormick, Blake Bodendorfer MD, Mark Hopkins MD, and Edward Chang MD © 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, Pennsylvania• Patients with lower socioeconomic status had delayed access to orthopedic care, increased preoperative instability, and a greater risk of bucket handle tears of the meniscus• Delays in care longer than 30 weeks increased the risk of bucket handle meniscus tearsLower Socioeconomic Status Adversely Affects Timing of Care and Rate of Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament InjuryREFERENCES• 230 patients met inclusion criteria; 126 responded to survey– Average age 26.5 years• Insurance Status– Private insurance saw orthopedics 39.48 ± 15.49 weeks earlier than government (p=0.012)• Language Spoken– Primary English speakers saw orthopedics 19.38 ± 7.08 weeks earlier (p=0.007)– Also had 0.81 ± 0.16 fewer reinjuries (p<.001)– Lower prevalence of bucket handle meniscus tears (OR 0.22, 0.047-0.59, P= 0.01)• Maximum Education Level– HS graduates saw orthopedics 301.38 ± 57.81 weeks earlier (p<.001)– College degree or higher saw orthopedics 36.5 ± 15.82 weeks earlier (p=.012)– No difference found with graduate degree (p=0.397)• Household Income– Income >$100k/year had 0.26 ±0.12 fewer repeat injuries (p=0.04)• Less likely to have a bucket handle tear at surgery (OR 0.14; 0.02-0.83)• Delay in Care– Delay in seeking care greater than 13 week were associated with higher rates of any meniscus tear– Delays greater than 30 weeks were associated with higher rates of bucket handle tears of the meniscus (p<0.001)• Delays in care associated with government insurance, lower education level, & ESL– Several studies have reported delayed orthopedic care in pediatric Medicare populations 5, 6– Study from Sweden reported lower education level was associated with decreased likelihood of ACL reconstruction 7• Increased instability associated with ESL and income <$100k/year– 1 episode of instability = 3x increase in likelihood of bucket handle tear 8– First study to associated specific tear type with socioeconomic status• Delay in care >30 weeks increases likelihood of bucket handle tear– Many reports of delayed ACL reconstruction increasing likelihood and severity of meniscus tears 1, 3, 8• Limitations– Recall bias & response rate– Data sampled from highly educated are• After IRB approval, all ACL reconstructions between 11/2015 and 8/2018 were queried using the Surgical Outcome System (Arthrex, Naples, FL)• Charts were reviewed for the following information:– Date of injury, date of 1st visit with orthopedic surgery, date or surgery, insurance status, type and location of any meniscus tear, and pre-injury activity level• Socioeconomic data was obtained through a REDcap survey asking patients to report primary language spoken at home, highest level of education achieved, household income, and number of reinjuries• Reminder emails sent five times; patients were then called twiceCaroline Fryar, MS, Andrew Curley, MD, David Wang, BS, Christine Conroy, BS, Brian McCormick, BA, Blake Bodendorfer, MD, Mark Hopkins, MD, Edward Chang, MDBackgroundMethodsResults DiscussionConclusions1. Lawrence JTR, Argawal N, Ganley TJ. Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med. 2011; 39(12):2582-2587.2. Williams AA, Mancini NS, Solomito MJ, Nissen CW, Milewski MD. Chondral Injuries and Irreparable Meniscal Tears Among Adolescents With Anterior Cruciate Ligament or Meniscal Tears Are More Common in Patients With Public Insurance. Am J Sports Med. 2017 Jul;45(9):2111-2115.3. Collins JE, Katz JN, Donnell-Fink LA, Martin SD, Losina E. Cumulative incidence of ACL reconstruction after ACL injury in adults: role of age, sex, and race. Am J Sports Med. 2013;41(3):544- 549.4. Crowley R, Daniel H, Cooney TG, et al, for the Health and Public Policy Committee of the American College of Physicians. Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care. Ann Intern Med. 2020;172:S7–S32.5. Pierce T, Mehlman C, Tamai J,Skaggs D. Access to care for the adolescent anterior cruciate ligament patient with Medicaid versus private insurance. J Pediatr Orthop. 2012 Apr-May; 32(3): 245–248.6. Skaggs DL, Lehmann CL, Rice C, Killelea BK, Bauer RM, Kay RM, Vitale MG. Access to orthopaedic care for children with medicaid versus private insurance: results of a national survey. J Pediatr Orthop. 2006 May-Jun; 26(3): 400–404.7. Nordenvall R, Marcano AI, Adami J, Palme M, Mattila VM, Bahmanyar S, Fellander-Tsai L. The Effect of Socioeconomic Status on the Choice of Treatment for Patients With Cruciate Ligament Injuries in the Knee: A Population-Based Cohort Study. Am J Sports Med. 2016 Nov;45(3).8. Anderson AF, Anderson CN. Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med. 2015 Feb; 43(2): 275–281.Problem Statement• Delayed treatment of ACL rupture know to increase pathology found at surgery1,2• Insurance established as risk factor 3• Cost also assumed to be a factor 4• No studies on the impact of other socioeconomic factors or the impact of these factors on the type of meniscus pathology at the time of ACL reconstruction1. Further define the impact of socioeconomic factors, including primary language spoken, on the timing of ACL reconstruction at our institution.2. Determine if these socioeconomic variables were associated with additional intra-articular pathology, such as bucket handle tears of the meniscus, at the time of surgery.© 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaProfessional clothes proof!

Lower Socioeconomic Status Adversely Affects Timing of Care and Rate of Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Injury

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1352&context=select-program

Lower Socioeconomic Status Adversely Affects Timing of Care and Rate of Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Injury

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