Paper 07: Race and Income Influence Patient Outcomes After Multiligament Knee Injuries

Abstract

Objectives: This study aimed to assess the influence of socioeconomic status (SES) variables on patient-reported outcomes and return to work following surgery for a multiligament knee injury. Methods: We retrospectively reviewed patients at our institution who underwent multi-ligament knee reconstruction between 2012 and 2022. SES variables of interest included median household income, occupation, race, sex, and marital status. International Knee Documentation Committee (IKDC) scores were used to assess clinical outcomes. Patients reported whether they had returned to work at final follow-up. Data was available for each SES variable for a subset of the cohort. Chi-square tests and Fisher exact tests were used to compare the proportion of patients who returned to work by race, sex, income, marital status, and job type (sedentary vs. nonsedentary) and to compare the proportion of patients with sedentary jobs within each demographic variable. Mann-Whitney U tests were used to compare the distribution of IKDC scores at final follow-up across the same demographic variables. Results: There were 144 patients with multiligament knee injuries for whom data on at least 1 SES variable was available with a median final follow-up of 3.2 years. Patients were 73.2% male with an average age of 38.8 years. Overall, 26.8% of patients were married and 56.1% of patients had sedentary jobs. Of the patients who were working before surgery (63% of the total cohort), 56.0% returned to work after surgery. There was a significant difference in the proportion of patients who had sedentary jobs by income (12.5% low income vs. 50.7% high income, p<.001) and who returned to work postoperatively (16.7% low income vs. 75.0% high income, p=.016). Median IKDC scores for white patients were 78.0 versus 65.5 for Black/African American patients; the score distributions in the two groups differed significantly (p=.045). Patient reported outcomes were not significantly different by sex or marital status. Conclusions: Only about half of patients returned to work after multiligament knee injury surgery. White race and higher income were predictive of better patient-reported outcomes following surgery for multiligament knee injuries. Determining the extent to which SES variables influence these outcomes may lead to improvements in rehabilitation and follow-up for diverse patients. Studies with larger cohorts are needed for a more comprehensive comparison of SES variables.