Yang Daniel, Orellana Kevin, Lee Julianna, Bram Joshua, Sarkar Sulagna, Renjilian Christopher B, Ganley Theodore J
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Orthop J Sports Med. 2024 Sep 27;12(9):23259671241248433. doi: 10.1177/23259671241248433. eCollection 2024 Sep.
Research at the intersection between social determinants of health (SDOH) and orthopaedics remains an area of active exploration, with recent literature demonstrating significant disparities in a wide array of orthopaedic outcomes in patients with different SDOH.
PURPOSE/HYPOTHESIS: The purpose of this study was to use a validated composite measure of SDOH mapped to census tracts (Child Opportunity Index [COI]) to explore disparities in functional outcomes after anterior cruciate ligament (ACL) reconstruction. It was hypothesized that patients with a lower COI score would have delayed surgical care and worse functional outcomes after ACL reconstruction.
Cohort study; Level of evidence, 3.
Demographic, surgical, and functional outcomes data were extracted for all patients aged ≤18 years who underwent primary ACL reconstruction at our institution between 2009 and 2019. Strength deficits were calculated, and COI quintile scores were obtained. One-way analysis of variance, the chi-square test, and the Fisher exact test were used to compare variables of interest between the lower 2 quintiles (low group) and the upper 2 quintiles (high group).
Of the 1027 patients, 226 (22.0%) were in the low group, while 801 (78.0%) were in the high group. There was a significantly greater time from injury to surgery in the low group than in the high group (98.15 ± 102.65 vs 71.79 ± 101.88 days, respectively; < .001). The low group had a significantly lower extension-flexion range of motion at 1- and 3-month follow-up ( = .03 and = .02, respectively) but no difference at 6-month follow-up ( = .27). The low group attended fewer physical therapy visits than the high group (24.82 ± 10.55 vs 37.81 ± 18.07, respectively; < .001). The low group had significant deficits in quadriceps strength at 3, 6, and 9 months at 180 deg/s ( = .03, < .001, and = .01, respectively) and at 6 months at 300 deg/s ( = .002).
In this study, we found that the COI was associated with disparities in key clinical outcomes including time to surgery, postoperative range of motion, and postoperative strength.
健康的社会决定因素（SDOH）与骨科交叉领域的研究仍是一个积极探索的领域，近期文献表明，具有不同SDOH的患者在一系列骨科治疗结果上存在显著差异。
目的/假设：本研究的目的是使用一种经过验证的、映射到人口普查区的SDOH综合测量指标（儿童机会指数[COI]），以探讨前交叉韧带（ACL）重建术后功能结果的差异。研究假设为，COI得分较低的患者在ACL重建术后接受手术治疗的时间会延迟，且功能结果较差。
队列研究；证据等级为3级。
提取了2009年至2019年期间在本机构接受初次ACL重建的所有年龄≤18岁患者的人口统计学、手术和功能结果数据。计算力量缺陷，并获得COI五分位数得分。使用单因素方差分析、卡方检验和Fisher精确检验，比较较低的2个五分位数组（低分组）和较高的2个五分位数组（高分组）之间的感兴趣变量。
在1027例患者中，226例（22.0%）属于低分组，而801例（78.0%）属于高分组。低分组从受伤到手术的时间显著长于高分组（分别为98.15±102.65天和71.79±101.88天；P<.001）。低分组在术后1个月和3个月时的屈伸活动范围显著更低（分别为P=.03和P=.02），但在术后6个月时无差异（P=.27）。低分组接受物理治疗的次数少于高分组（分别为24.82±10.55次和37.81±18.07次；P<.001）。低分组在术后3个月、6个月和9个月时，在180°/秒的速度下股四头肌力量有显著缺陷（分别为P=.03、P<.001和P=.01），在术后6个月时，在300°/秒的速度下也有显著缺陷（P=.002）。
在本研究中，我们发现COI与包括手术时间、术后活动范围和术后力量等关键临床结果的差异相关。
