The Impact of Socioeconomic Factors on Outcomes Following Anterior Cruciate Ligament Reconstruction (209)

OBJECTIVES: Socioeconomic factors have been shown to impact patient care in many surgical fields; however, their effects have not been thoroughly evaluated in the context of anterior cruciate ligament reconstruction (ACLR) outcomes. The purpose of this study is to investigate the effects of socioeconomic factors on time to surgery, knee function, and subjective outcomes measures following ACLR. METHODS: A retrospective query of primary ACLR surgeries at a single institution performed from 2011 to 2015 with minimum two-year follow-up was conducted. Patient demographics, insurance type, worker’s compensation status, surgical variables, IKDC score, and failure were recorded from chart review. Education level and income were obtained via phone interview. Differences between functional outcome were compared between Medicaid and non-Medicaid groups. RESULTS: 268 patients were included in the analysis (43 patients in the Medicaid group and 225 patients in the non-Medicaid group). The Medicaid group demonstrated lower annual income (p<0.01) and a lower level of completed education compared to the non-Medicaid group (p<0.01). Medicaid patients had a greater duration between time of initial knee injury and surgery compared to the non-Medicaid group (11.8 +/- 16.3 months versus 6.1 +/- 16.5 months, p = 0.04). At the time of follow-up, patients in the non-Medicaid group had a significantly greater IKDC score compared to Medicaid patients (82.5 +/- 13.8 versus 75.3 +/- 20.8, p = 0.03). CONCLUSIONS: Socioeconomic factors impacted care in the setting of ACL injury. Medicaid insurance patients were seen significantly later after initial injury when compared to non-Medicaid carriers, and had worse outcomes compared to their non-Medicaid peers. Higher annual income brackets had significantly higher clinical outcomes scores at a minimum of two years postoperatively. Education level did not affect outcomes.