Abstract
Objectives:
Literature has shown that there are differences in care across demographics for sports- related injuries. Delay to physician evaluation, delay to surgery, and decreased surgical management has been documented in common pathology such as ACL tears and Shoulder Instability. Recent research has demonstrated that for Patellar Instability in adolescents, African-American patients had lower odds of having surgical management in addition to their care costing more overall, even when controlled for insurance status. The Hispanic population is a growing minority group who face challenges not just in economic status, but language barriers that may also impart inequitable care for one of the most common diagnoses seen in a Sports clinic. The purpose of this study is to assess for any major differences in care provided to adolescent patients who identify as Hispanic compared to the remainder of the adolescent population.
Methods:
Patellar Instability patients who underwent MPFL Reconstruction at a single center between September 2008 through December 2015 were collected. Inclusion criteria were age < 19 at time of surgery, preoperative and postoperative data available during chart review, case was performed as the index primary reconstructive procedure, and minimum of 3 month follow-up data available. Charts were reviewed to gather demographic and clinical information including age, sex, race, ethnicity, number of instability episodes, MRI at time of initial evaluation, time from injury to surgery, engagement in postoperative physical therapy, number of postoperative visits attended, Kujala score, and complications. Independent variable t-test was used for analysis of number of clinic visits, therapy sessions, and the Kujala score. The remainder of analysis was completed using χ2 testing. Significance was set at p = 0.05.
Results:
95 patients (40 male (42%), 55 female (58%)) met the inclusion criteria. Mean patient age was 15.5. 37 patients identified as Hispanic (38.9%) and 58 (61.1%) of patients identified as non-Hispanic. 58.5% of all patients had an MRI available at their first clinic visit, 69.2% of patients had 2 or more dislocation events prior to surgery, and 37% of patients were formally cleared for return to activity. Hispanic patients more frequently had an MRI prior to surgery compared to non-Hispanic patients (73% vs 50%, p = .039). Otherwise, there was no statistically significant difference in observations between Hispanics patients and non-Hispanic patients, including number of dislocations prior to surgery (p = 0.13), number of clinic visits preoperatively or postoperatively (p = 0.51 and 0.09, respectively), number of therapy sessions attended postoperatively (p = 0.46), or the patient reported outcome as measured by the Kujala score (mean = 91.56 vs 95.25, p = 0.13). Complications in the cohort included 1 infection and 1 case of arthrofibrosis. 2 patients in the Hispanic cohort required revision for recurrent instability compared with 5 patients in the non-Hispanic cohort (p = 0.56).
Conclusions:
Adolescents with patellar instability who identify as Hispanic had similar outcomes scores and complication rates after operative treatment in the form of MPFL Reconstruction. Hispanic patients more frequently had an MRI at their first clinic visit prior to surgery, but the remainder of the perioperative work-up and care was similar to the non-Hispanic cohort. Though significant deviations in care were not found in this study, reviews to elucidate any variations in care should continue in efforts to ensure equitable treatment of at-risk populations.