儿童前交叉韧带重建就诊后延迟的社会人口学预测因素及其关节内损伤严重程度
简介
本研究回顾443例2013—2025年行ACL重建的儿科患者，分析种族、保险类型及社区机会指数对就诊后手术延迟（>120天）的影响。结果显示，非西班牙裔黑人、西班牙裔、公共保险及低社区机会均独立预测延迟，且延迟每增加1天，高等级软骨损伤风险增加0.4%。提示系统层面延迟是造成儿科ACLR差异的主因，应优化资源分配以减少继发关节损伤。
英文摘要
BACKGROUND: Delayed anterior cruciate ligament reconstruction (ACLR) in pediatric patients is associated with progressive intra-articular injury. Although disparities in access to orthopaedic care have been reported, it remains unclear whether structural determinants of health influence postpresentation surgical delay and downstream functional recovery. PURPOSE: To determine whether sociodemographic and structural determinants are associated with prolonged postpresentation delay to pediatric ACLR and with intra-articular injury severity and postoperative functional outcomes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The records of 443 pediatric patients who underwent ACLR (2013-2025) at an urban academic referral center with a pediatric orthopaedic urgent care were reviewed. Exposures included race/ethnicity, insurance type, and neighborhood deprivation (Childhood Opportunity Index [COI]). Delay was defined as time from first orthopaedic presentation to surgery, with prolonged delay defined as >120 days. Outcomes included high-grade cartilage injury (Outerbridge grade 3 or 4), meniscal tear presence, failure to return to sport (≥365 days of follow-up), hop test symmetry, isometric strength symmetry, and graft failure. Multivariable regression models were adjusted for race/ethnicity, age, sex, insurance, and national COI. RESULTS: The median time from injury to presentation was 5 days, while the median postpresentation time to surgery was 101 days; 38.6% experienced prolonged delay. In adjusted logistic regression, non-Hispanic Black, Hispanic, and other/unknown race/ethnicity; public insurance; and lower neighborhood opportunity were each independently associated with prolonged delay. Continuous postpresentation delay was independently associated with increased odds of high-grade cartilage injury (OR, 1.004 per day; 95% CI, 1.000-1.008; P = .048). Among patients with ≥365 days of follow-up (n = 228), public insurance was not independently associated with failure to return to sport (OR, 1.69; P = .398). Among those completing functional testing (n = 150), public insurance (β = +9.14; P = .046), higher national COI (β = +0.14 per unit; P = .045), and male sex (β = +9.59; P = .010) were each independently associated with greater hop test asymmetry, whereas no independent associations were observed for isometric strength symmetry or graft failure. CONCLUSION: Disparities in pediatric ACLR are driven primarily by postpresentation system-level delays and are associated with an incrementally greater risk of cartilage injury.