Clinical and Social Predictors of Surgical Treatment for Anterior Cruciate Ligament Injuries

While anterior cruciate ligament (ACL) injury is often managed surgically in the young, active population, nonoperative management may be considered in older adults. Surgical decision-making in adults is usually based on patient preference, level of functional disability, and the presence of comorbidities. Understanding the role of clinical predictors in surgical decision-making can help identify disparities in treatment outcomes.

To report on clinical and social predictors of surgical versus nonsurgical treatment in patients with ACL injuries and quantify the influence of each factor.

Case control study; Level of evidence, 3.

Patients diagnosed with ACL injury and those who underwent subsequent ACL reconstruction at a single center were identified. Functional disability was determined using patient-reported outcome measure scores, including the Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and Patient-Reported Outcomes Measurement Information Systems Physical Function (PROMIS-PF) within 90 days of diagnosis and before surgery. Clinical and sociodemographic factors were collected, and comorbidities were recorded using the Charlson Comorbidity Index. Logistic regression analysis was performed to identify relationships between clinical and sociodemographic factors with the likelihood of undergoing surgery for their ACL injury.

A total of 3656 patients were identified with ACL tear; 1734 (47.4%) were female (mean age, 34.9 years; SD, 13.8 years) and 1922 (52.6%) were male (mean age, 32.8 years; SD, 13.1 years). Overall, 53.8% of female patients and 53.4% of male patients underwent surgical treatment. Women had lower KOOS-PS and PROMIS values compared with men (-4.1 [P < .001] and -2.0 [P < .001], respectively) at the time of initial evaluation. Older age (P < .001), greater body mass index (P = .014), greater comorbidities (P < .001), smoking (P = .06), and subsidized insurance (P < .001) were negative predictors of surgery.

Older age, greater body mass index, greater comorbidities, smoking, and subsidized insurance were negative predictors of undergoing surgical management of ACL injuries. Clinical predictors are useful in highlighting disparities and understanding ACL reconstruction decision-making for patients.