Karnuta Jaret M, Dalton Sarah, Bena James, Farrow Lutul D, Featherall Joseph, Jones Morgan H, Miniaci Anthony A, Parker Richard D, Rosneck James T, Saluan Paul, Strnad Greg, Spindler Kurt P, Williams James S, Oak Sameer R
Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA.
Orthop J Sports Med. 2021 Apr 26;9(4):2325967121994833. doi: 10.1177/2325967121994833. eCollection 2021 Apr.
Opioid use and public insurance have been correlated with worse outcomes in a number of orthopaedic surgeries. These factors have not been investigated with anterior cruciate ligament reconstruction (ACLR).
PURPOSE/HYPOTHESIS: To evaluate if narcotic use, physical therapy location, and insurance type are predictors of patient-reported outcomes after ACLR. It was hypothesized that at 1 year postsurgically, increased postoperative narcotic use would be associated with worse outcomes, physical therapy obtained within the authors' integrated health care system would lead to better outcomes, and public insurance would lead to worse outcomes and athletic activity.
Cohort study; Level of evidence, 2.
All patients undergoing unilateral, primary ACLR between January 2015 and February 2016 at a large health system were enrolled in a standard-of-care prospective cohort. Knee injury and Osteoarthritis Score (KOOS) and the Hospital for Special Surgery Pediatric-Functional Activity Brief Scale (HSS Pedi-FABS) were collected before surgery and at 1 year postoperatively. Concomitant knee pathology was assessed arthroscopically and electronically captured. Patient records were analyzed to determine physical therapy location, insurance status, and narcotic use. Multivariable regression analyses were used to identify significant predictors of the KOOS and HSS Pedi-FABS score.
A total of 258 patients were included in the analysis (mean age, 25.8; 51.2% women). In multivariable regression analysis, narcotic use, physical therapy location, and insurance type were not independent predictors of any KOOS subscales. Public insurance was associated with a lower HSS Pedi-FABS score (-4.551, = .047) in multivariable analysis. Narcotic use or physical therapy location was not associated with the HSS Pedi-FABS score.
Increased narcotic use surrounding surgery, physical therapy location within the authors' health care system, and public versus private insurance were not associated with disease-specific KOOS subscale scores. Patients with public insurance had worse HSS Pedi-FABS activity scores compared with patients with private insurance, but neither narcotic use nor physical therapy location was associated with activity scores. Physical therapy location did not influence outcomes, suggesting that patients be given a choice in the location they received physical therapy (as long as a standardized protocol is followed) to maximize compliance.
在许多骨科手术中，阿片类药物的使用和公共保险与较差的预后相关。但这些因素在前交叉韧带重建术（ACLR）中尚未得到研究。
目的/假设：评估麻醉药物使用、物理治疗地点和保险类型是否为ACLR术后患者报告结局的预测因素。研究假设为，术后1年时，术后麻醉药物使用增加将与更差的结局相关，在作者所在的综合医疗保健系统内接受物理治疗会带来更好的结局，而公共保险会导致更差的结局和体育活动水平。
队列研究；证据等级为2级。
2015年1月至2016年2月期间，在一个大型医疗系统中接受单侧初次ACLR的所有患者被纳入一项标准治疗前瞻性队列研究。在手术前和术后1年收集膝关节损伤和骨关节炎评分（KOOS）以及特殊外科医院儿童功能活动简表（HSS Pedi-FABS）。通过关节镜检查评估并电子记录伴随的膝关节病变情况。分析患者记录以确定物理治疗地点、保险状况和麻醉药物使用情况。采用多变量回归分析来确定KOOS和HSS Pedi-FABS评分的显著预测因素。
共有258例患者纳入分析（平均年龄25.8岁；51.2%为女性）。在多变量回归分析中，麻醉药物使用、物理治疗地点和保险类型均不是任何KOOS子量表的独立预测因素。在多变量分析中，公共保险与较低的HSS Pedi-FABS评分相关（-4.551，P = 0.047）。麻醉药物使用或物理治疗地点与HSS Pedi-FABS评分无关。
围手术期麻醉药物使用增加、作者所在医疗保健系统内的物理治疗地点以及公共保险与私人保险，均与特定疾病的KOOS子量表评分无关。与私人保险患者相比，公共保险患者的HSS Pedi-FABS活动评分更差，但麻醉药物使用和物理治疗地点均与活动评分无关。物理治疗地点不影响结局，这表明应给予患者选择接受物理治疗地点的权利（只要遵循标准化方案）以最大程度提高依从性。
