Poster 335: Increased Body Mass Index is Associated with Increased time to Imaging and Surgery in Young Athletes with Anterior Cruciate Ligament Injury

Abstract

Objectives: For young athletes with anterior cruciate ligament (ACL) injury, ACL reconstruction is usually recommended to restore stability to the knee. Previous studies have shown that increased time from ACL injury to ACL reconstruction can lead to the accrual of new injuries over time, specifically medial meniscus tears. In addition, increased time from magnetic resonance imaging (MRI) to ACL reconstruction in these patients decreases the predictive value of MRI imaging as a diagnostic tool for concomitant injuries. However, risk factors for delay in care for ACL injuries remain undetermined. To our knowledge, no prior study has examined the impact of social determinants of health on the timing of MRI and ACL reconstruction after ACL injury in young athletic patients. The goal of this study is to investigate what social determinants of health may impact timing of care in young athletes with ACL injury. Methods: We retrospectively reviewed the electronic medical records of all patients aged 13-25 years at a single orthopaedic surgery department who underwent isolated primary ACL reconstruction from January 2017 to June 2020. We excluded patients who were not self-reported athletes or charts without MRI, operative report, or date of initial injury. We documented the time from injury to MRI, MRI to surgery, and injury to surgery. Demographics were recorded including age, gender, body mass index (BMI), race/ethnicity, and insurance type (public versus private). Multivariable analysis was used to determine if any demographic factor had a significant association with increased time to MRI or surgery after initial injury. Results: A total of 432 patients met inclusion and exclusion criteria (mean age 17.9, 46% male). On multivariable analysis, there were significant associations between BMI and timing of care while holding all other predictors constant. There were 249 patients with normal BMI, 106 overweight (BMI 25 – 29.9), 60 obese (BMI >= 30), and 17 underweight (BMI < 18.5). Patients with obese BMI had an injury to MRI time that was on average 77.6 (95% CI: 20.7–193.4; p = 0.015) days longer than those with normal BMI, and an increased time from injury to surgery that was on average 107.2 [95% CI 11.3–203.1; p < 0.029] days longer than those with normal BMI. Patients with overweight BMI had an MRI to surgery time that was on average 34.3 [95% CI: 9.2–59.4; p < 0.007] days longer than those with normal BMI and an injury to surgery time that was on average 74.6 [95% CI: 2.3–147; p < 0.043] days longer than those with a normal BMI. No other demographic factors had a statistically significant association with the timing of care, although public insurance and minority race/ethnicity trended toward delays in care. Conclusions: This multivariable analysis of over 400 patients from a single institution demonstrates that athletes with ACL injuries that have higher BMI experience increased time to MRI and surgical care compared to patients with normal BMI when controlling for other variables. While the cause of the delay for this group may be multifactorial, understanding this disparity in health care and using it to uncover our hidden biases may help us provide better patient care to all.