Context

There are significant disparities in access to health care, but there are limited data about the impact of race and socioeconomic status (SES) on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction (ACLR) surgery.

Objective

To identify associations between area deprivation index (ADI), strength measures and patient-reported outcomes (PROs) following ACLR as well as to examine differences in outcomes between race, sex, and race.

Design

Case control study in a single hospital setting.

Setting

Database secondary analysis.

Patients or Other Participants

Data was collected from 340 patients who underwent primary, isolated, unilateral ACLR.

Main Outcome Measures

Strength measures and PROs were obtained at patients’ postoperative assessments at approximately six months post-surgery. Area Deprivation Index values were calculated on each patient’s census tract, determined through medical records review. Correlations were conducted to determine the relationship between ADI and KOOS measures, IKDC, and limb symmetry on strength measurements. The racial composition of the sample was heavily skewed and was excluded from statistical analyses.

Results

ADI was weakly correlated with IKDC (ρ=0.11, p=0.04) outcomes, with more disadvantaged patients reporting better quality of life and knee function. ADI was not correlated with other outcomes of interest. The median ADI value of the sample was 32 (range 1-86 [IQR 19-47]).

Conclusions

Our study revealed a weak correlation between higher levels of socioeconomic disadvantage as measured by ADI and improved subjective assessment of knee function and quality of life as measured by IKDC. These findings are contrary to what other studies on this subject have found and highlight the importance of further research into the impact of SES and other social determinants of health on post ACLR outcomes.

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