pediatric ACL reconstruction; insurance status; access to care


BACKGROUND: Anterior cruciate ligament injuries (ACL) of the knee are becoming increasingly common in the pediatric and adolescent population with the rise in organized sports participation. This injury can be devastating to a young athlete’s ability to engage in physical activity as the knee is rendered unstable; leaving it susceptible to further degenerative changes. As a result, a delay in both the diagnosis and treatment of ACL injuries can lead to secondary joint damage in this highly active population. The purpose of this study was to analyze whether the insurance status and race of pediatric and adolescent patients with ACL injuries impacts the time from injury to diagnosis and treatment, and consequently secondary joint damage.

MATERIALS AND METHODS: This was a retrospective review of 170 consecutive patients at a tertiary care pediatric hospital treated by a single surgeon from 2011 to 2015 for ACL ruptures. The institution at which the patients were treated was a safety-net hospital that provides a significant level of care to low-income, uninsured, and vulnerable populations with no care preference given based on insurance status. Patients were stratified into public insurance and private insurance groups. Race was also considered. Ability to access care was compared between the groups in regards to time from injury to magnetic resonance imaging (MRI) exam (the gold standard for diagnosis of ACL injury) as well time from injury to surgical reconstruction. In addition, the presence of secondary injury (meniscal / chondral injury) that may have stemmed from treatment delay and continued activity with an unstable knee was compared between groups.

RESULTS: One hundred and two patients had public insurance and 68 patients had private insurance. Patients with private insurance received an MRI nearly 50% faster after their injury (p < 0.001, 19 days vs. 38 days). In addition, time from injury to ACL reconstruction was also faster (p < 0.001, 61 days vs. 96 days) for privately insured patients. An increased rate of meniscal tears and chondral injuries was not significantly seen in the public insurance group. Race did not impact timing to treatment or secondary injuries.

CONCLUSIONS: The results of this study demonstrated that time from injury to MRI diagnosis, and surgical treatment was significantly shorter in privately insured pediatric and adolescent patients even in a safety-net hospital setting. Clinicians must be cognizant of this disparity and develop means to ensure timely access to care.