Farrow Lutul D, Scarcella Michael J, Wentt Christa L, Jones Morgan H, Spindler Kurt P, Briskin Isaac, Leo Brian M, McCoy Brett W, Miniaci Anthony A, Parker Richard D, Rosneck James T, Sabo Frank M, Saluan Paul M, Serna Alfred, Stearns Kim L, Strnad Gregory J, Williams James S
Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA.
Orthop J Sports Med. 2022 Sep 30;10(9):23259671221117486. doi: 10.1177/23259671221117486. eCollection 2022 Sep.
It is unknown whether race- or insurance-based disparities in health care exist regarding baseline knee pain, knee function, complete meniscal tear, or articular cartilage damage in patients who undergo anterior cruciate ligament reconstruction (ACLR).
Black patients and patients with Medicaid evaluated for ACLR would have worse baseline knee pain, worse knee function, and greater odds of having a complete meniscal tear.
Cross-sectional study; Level of evidence, 3.
A cohort of patients (N = 1463; 81% White, 14% Black, 5% Other race; median age, 22 years) who underwent ACLR between February 2015 and December 2018 was selected from an institutional database. Patients who underwent concomitant procedures and patients of undisclosed race or self-pay status were excluded. The associations of race with preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale, KOOS Function subscale, and intraoperatively assessed complete meniscal tear (tear that extended through both the superior and the inferior meniscal surfaces) were determined via multivariate modeling with adjustment for age, sex, insurance status, years of education, smoking status, body mass index (BMI), meniscal tear location, and Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS).
The 3 factors most strongly associated with worse KOOS Pain and KOOS Function were lower VR-12 MCS score, increased BMI, and increased age. Except for age, the other two factors had an unequal distribution between Black and White patients. Univariate analysis demonstrated equal baseline median KOOS Pain scores (Black, 72.2; White, 72.2) and KOOS Function scores (Black, 68.2; White, 68.2). After adjusting for confounding variables, there was no significant difference between Black and White patients in KOOS Pain, KOOS Function, or complete meniscal tears. Insurance status was not a significant predictor of KOOS Pain, KOOS Function, or complete meniscal tear.
There were clinically significant differences between Black and White patients evaluated for ACLR. After accounting for confounding factors, no difference was observed between Black and White patients in knee pain, knee function, or complete meniscal tear. Insurance was not a clinically significant predictor of knee pain, knee function, or complete meniscal tear.
对于接受前交叉韧带重建术（ACLR）的患者，在基线膝关节疼痛、膝关节功能、半月板完全撕裂或关节软骨损伤方面，基于种族或保险的医疗保健差异是否存在尚不清楚。
接受ACLR评估的黑人患者和医疗补助患者的基线膝关节疼痛更严重、膝关节功能更差，且半月板完全撕裂的几率更高。
横断面研究；证据等级，3级。
从一个机构数据库中选取2015年2月至2018年12月期间接受ACLR的一组患者（N = 1463；81%为白人，14%为黑人，5%为其他种族；中位年龄22岁）。排除接受了同期手术的患者以及种族或自费状态未披露的患者。通过多变量建模确定种族与术前膝关节损伤和骨关节炎结局评分（KOOS）疼痛子量表、KOOS功能子量表以及术中评估的半月板完全撕裂（延伸至半月板上下表面的撕裂）之间的关联，并对年龄、性别、保险状态、教育年限、吸烟状态、体重指数（BMI）、半月板撕裂位置和退伍军人兰德12项健康调查心理成分评分（VR - 12 MCS）进行调整。
与KOOS疼痛和KOOS功能较差最密切相关的3个因素是较低的VR - 12 MCS评分、较高的BMI和较高的年龄。除年龄外，其他两个因素在黑人和白人患者之间分布不均。单因素分析显示，基线KOOS疼痛评分中位数（黑人，72.2；白人，72.2）和KOOS功能评分中位数（黑人，68.2；白人，68.2）相等。在对混杂变量进行调整后，黑人和白人患者在KOOS疼痛、KOOS功能或半月板完全撕裂方面无显著差异。保险状态不是KOOS疼痛、KOOS功能或半月板完全撕裂的显著预测因素。
接受ACLR评估的黑人和白人患者之间存在临床显著差异。在考虑混杂因素后，黑人和白人患者在膝关节疼痛、膝关节功能或半月板完全撕裂方面未观察到差异。保险不是膝关节疼痛、膝关节功能或半月板完全撕裂的临床显著预测因素。
