Troyer Luke, Voshage Aaron, Rucinski Kylee, DeFroda Steven, Cook James L
School of Medicine, University of Missouri, Columbia, MO, USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
J Orthop. 2024 Jul 18;59:90-96. doi: 10.1016/j.jor.2024.07.012. eCollection 2025 Jan.
Over 200,000 anterior cruciate ligament (ACL) injuries occur in the United States each year. While many patients choose to pursue ACL reconstruction (ACLR), the impact of social determinants of health (SDOH) on outcomes is unclear.
The purpose of this study was to review and synthesize current literature to determine the impact of SDOH on outcomes following ACL reconstruction.
A systematic search of PubMed, CINAHL, Medline, PsychINFO, and Scopus was completed.
Articles reporting outcomes following ACLR were included if they discussed at least one SDOH and provided ACLR failure rates.
Systematic review.
Level I.
After screening 712 studies, 13 were found that met inclusion criteria and were analyzed. Studies commonly examined the correlations between race, income, location, education, and insurance on outcomes following ACLR. Three studies found that the ACL revision risk for Black patients compared to White patients ranged from 0.23 to 0.78, while the revision risk for Hispanic patients compared to White patients ranged from 0.7 to 0.83. One study reported finding that the odds ratio of revision for the White patients was 1.32. Another study reported no difference in revision risk based on race. Patients living in urban areas were found to have improved outcomes compared to rural areas (Mean IKDC (Urban 85.3 vs Rural 81.87) and Tegner-Lysholm (Urban 88.26 vs Rural 84.82)). Lower socioeconomic status was correlated with decreased post-operative functional scores (KOOS, Marx and IKDC).
Several SDOH such as White race, rural location, and low socioeconomic status may be independently correlated with worse ACLR outcomes in the form of increased revision rates or worse post-operative functional scores. However, further research is needed to better elucidate the degree of impact and interconnectedness of SDOH domains on ACLR patient outcomes.
美国每年有超过20万例前交叉韧带（ACL）损伤。虽然许多患者选择进行ACL重建（ACLR），但健康的社会决定因素（SDOH）对治疗结果的影响尚不清楚。
本研究的目的是回顾和综合当前文献，以确定SDOH对ACL重建后治疗结果的影响。
完成了对PubMed、CINAHL、Medline、PsychINFO和Scopus的系统检索。
如果文章讨论了至少一个SDOH并提供了ACLR失败率，则纳入报告ACLR后治疗结果的文章。
系统评价。
I级。
在筛选的712项研究中，发现13项符合纳入标准并进行了分析。研究通常考察了种族、收入、地理位置、教育程度和保险与ACLR后治疗结果之间的相关性。三项研究发现，黑人患者与白人患者相比，ACL翻修风险在0.23至0.78之间，而西班牙裔患者与白人患者相比，翻修风险在0.7至0.83之间。一项研究报告称，白人患者翻修的优势比为1.32。另一项研究报告称，基于种族的翻修风险没有差异。与农村地区相比，城市地区的患者治疗结果有所改善（平均IKDC评分（城市85.3 vs农村81.87）和Tegner-Lysholm评分（城市88.26 vs农村84.82））。社会经济地位较低与术后功能评分降低相关（KOOS、Marx和IKDC评分）。
一些SDOH，如白人种族、农村地理位置和低社会经济地位，可能以翻修率增加或术后功能评分更差的形式与更差的ACLR结果独立相关。然而，需要进一步的研究来更好地阐明SDOH领域对ACLR患者治疗结果的影响程度和相互关联性。
