Decrease in Pediatric Anterior Cruciate Ligament Injury-related Care Disparities for Medicaid Patients From 2015 to...

Anterior cruciate ligament (ACL) injuries are relatively common in the pediatric population, and ACL reconstruction (ACLR) followed by postoperative physical therapy (PT) is frequently considered to decrease the risk of additional knee injury and improve functional outcomes. Disparities across insurance groups in ACL surgical rates and PT utilization have been previously reported, but there is limited analysis from national databases, and even less about disparity trends over time.

The 2015 to 2020 M157 PearlDiver database was queried for patients younger than 18 years diagnosed with ACL injury with commercial or Medicaid insurance. Factors abstracted included year, insurance plan, ACLR or not, and PT utilization and number of visits. The incidence of ACLR and PT visits were compared across insurance groups by year.

In total, 61,333 ACL injuries were identified for which ACLR was done for 21,083 (34.4%). The incidence of reconstruction was higher for those with commercial than Medicaid (35.0% vs. 30.7%, P < 0.001). Over the years of the study, this gap decreased from 7.7% in 2015 (P < 0.001) to 0.7% in 2020 (P = 0.714). For postoperative patients, those with commercial insurance had more PT sessions (26.45 vs. 22.53, P < 0.001). This gap decreased from 6.48 sessions in 2015 (P < 0.001) to 4.07 sessions in 2020 (P = 0.002). For nonsurgical patients, those with commercial insurance were more likely to receive PT (43.3% vs. 39.8%, P < 0.001) and to receive more sessions (18.76 vs. 14.35, P < 0.001). The gap in PT incidence deceased from 9.7% in 2015 (P < 0.001) to 2.4% in 2020 (P = 0.200).

Medicaid pediatric patients with ACL injuries were markedly less likely to undergo reconstruction and received less PT than commercial insurance patients, but these differences decreased/disappeared over the years studied. It is reassuring to see these insurance-related disparities decreasing over time, and continued access efforts are needed.