Abstract
Objectives:
Despite recent advancements in surgical techniques and rehabilitation protocols, anterior cruciate ligament (ACL) rupture remains a devastating injury for patients. Prior studies have reported that general public knowledge regarding ACL reconstruction is poor, even among patients with high self-reported understanding of the structure and procedure. However, the influence of demographic and socioeconomic factors on patient knowledge remains poorly understood. Identifying patient groups that may benefit from additional informational material regarding ACL reconstruction surgery could help to guide informed consent practices and help to improve patient-centered care.
The aims of this study were two-fold. First, we utilized an ACL knowledge questionnaire to assess general orthopaedic patient knowledge of ACL injury and treatment and investigated how socioeconomic factors may contribute to patient knowledge. Second, we compared survey responses of NCAA Division I athletes to the general orthopaedic patient population to understand how activity level may influence patient knowledge of ACL injury and treatment.
Methods:
This study received Institutional Review Board approval prior to data collection. Study participants were patients aged 18-50 from outpatient orthopaedic surgery sports medicine clinics at a single urban academic medical center and NCAA Division 1 athletes aged 18 to 23. A previously published questionnaire assessing knowledge regarding ACL reconstruction surgery was adapted to include items such as insurance status, education level, and socioeconomic status. Responses were collected between June 2023 and August 2023, and stored on the REDCap secure online platform. Statistical analysis was performed via SPSS (© IBM Corp).
Results:
General Public
There were 144 general public patient respondents. This group consisted of 47.9% males and 51.4% females at a mean age of 37.1 years (SD 9.4 years). The largest proportion of respondents were African-American (38.2%), followed by Caucasian (29.2%), Hispanic (22.9%), Asian (3.5%), and other (6.3%). Most respondents did not have a college degree (66.7%), with 2.8% having some elementary/middle school education, 6.9% having some high school education, 31.3% having a high school degree, and 25.7% having some college education. Only 22.2% of respondents had a college degree, and 10.4% had a graduate/professional degree. About one-third of respondents (36.1%) have been employed in healthcare. Almost all respondents had health insurance (97.9%), with 38.2% private insurance, 29.9% Medicare, and 27.1% Medicaid. The mean Marx Activity Rating Scale (MARS) score was 4.4 (SD 5.4). Nearly half (49.4%) of respondents have consulted with a health-care provider regarding knee pain or a knee injury in the past, with 8.5% having been diagnosed with an ACL rupture and 5.2% having undergone an ACL reconstruction. Three-fourths of respondents (75.8%) reported having no knowledge about the ACL (32.0%) or little knowledge about the ACL (43.8%). Of the remaining respondents, 17.6% had moderate knowledge about the ACL, 3.9% had considerable knowledge about the ACL, and 2.6% had extensive knowledge about the ACL.
The mean score on the ACL questionnaire was 32.8% correct (SD 17.2). Mean MARS scores and mean ACL questionnaire scores by demographics are presented in Table 1. Males had a significantly higher mean MARS score compared to females (6.3 vs 3.0; p<0.01), with no significant difference in ACL questionnaire scores. Caucasian respondents scored significantly higher on the ACL questionnaire compared to other race/ethnicity groups (43.9% vs 28.3%; p<0.01), with no significant difference in MARS scores. Respondents with an education level beyond high school scored significantly higher on the ACL questionnaire compared to respondents with a high school degree or below (38.4% vs 24.8%; p<0.01), with no significant difference in MARS scores. Respondents with a history of employment in healthcare scored significantly higher on the ACL questionnaire compared to those without (37.8% vs 30.1%; p=0.01). Compared to respondents with Medicare and Medicaid, respondents with private insurance scored significantly higher on the ACL questionnaire (39.4% vs 28.3%; p<0.01) and had significantly higher MARS scores (5.9 vs 3.3; p=0.02).
Collegiate Athletes
There were 22 Division I collegiate athlete respondents across multiple sports. Respondents consisted of 72.7% females and 27.3% males at a mean age of 18.9 years (SD 1.3). About half of the athlete respondents were Caucasian (54.5%), followed by African-American (13.6%), Asian (9.1%), Hispanic (4.5%), and Other (18.2%). About one in ten (9.1%) athletes had been previously employed in a healthcare setting. Over half of athlete respondents (54.5%) reported having no knowledge about the ACL (13.6%) or little knowledge about the ACL (40.9%). About one-third (36.4%) reported having moderate knowledge, 9.1% reported having considerable knowledge, and zero reported having extensive knowledge about the ACL. The mean ACL questionnaire score among athletes was 54.7% (SD 19.7), and the mean MARS score was 13.0 (SD 3.9). Compared to the general population, collegiate athlete respondents had a significantly higher MARS score (13.0 vs 4.5; p<0.01) and scored significantly higher on the ACL questionnaire (54.7% vs 32.8%; p<0.01). (Figures 1 & 2)
Conclusions:
This study revealed that both general orthopaedic patient knowledge and collegiate athlete knowledge regarding ACL reconstruction remain low. Race/ethnicity, education level, and insurance status significantly contribute to differences in patient knowledge. Collegiate athletes are significantly more active and have significantly greater knowledge of ACL injuries and treatment compared to the general population.
