Mercurio Angela M, Coene Ryan P, Cook Danielle L, Feldman Lanna, Milewski Matthew D
Harvard Medical School, Boston, Massachusetts, USA.
Boston Children's Hospital, Boston, Massachusetts, USA.
Am J Sports Med. 2022 Sep;50(11):2909-2916. doi: 10.1177/03635465221109607. Epub 2022 Aug 2.
The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment.
Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction.
Descriptive epidemiology study.
The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations.
A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all < .05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all < .05). There were no associations detected between income bracket and the outcomes in this study.
This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair.
随着时间的推移，儿科/青少年人群中前交叉韧带（ACL）重建的发生率在增加，但关于半月板相关手术如何随时间变化的证据较少。也缺乏数据表明哪些特征与半月板切除术和半月板修复治疗相关。
年龄、性别、种族/民族、收入和保险类型可能独立影响接受ACL重建的儿科患者的半月板相关手术发生率和治疗方式。
描述性流行病学研究。
查询儿科健康信息系统数据库，以获取2015年至2019年期间年龄≤18岁、接受或未接受半月板相关手术的ACL重建患者。收集基本人口统计学数据，包括年龄、性别、自我认定的种族/民族、城乡通勤区号、预测的中位数收入和保险状况。使用线性回归对趋势进行建模，并使用多元逻辑回归建模来检验相关性。
在研究期间，共有14398名年龄≤18岁的患者接受了ACL重建，其中8337名患者（58%）进行了半月板相关手术，5年内增加了1.24倍。在半月板相关治疗队列中，41%接受了半月板切除术，59%接受了半月板修复术。在研究期间，半月板切除术有0.82倍的变化，半月板修复术增加了1.67倍。男性患者、年龄较大的患者、黑人、居住在城市地区以及拥有非私人保险的患者接受半月板相关手术的几率增加（均P<0.05）。非白人种族患者和拥有非私人保险的患者接受半月板切除术而非半月板修复术的几率增加（均P<0.05）。本研究未发现收入水平与结果之间存在关联。
本研究表明，在接受ACL重建的儿科和青少年患者中，2015年至2019年期间半月板相关手术有所增加。此外，非白人种族患者和拥有非私人保险的患者接受半月板切除术而非半月板修复术的几率增加。
