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Delays in Orthopaedic Care and Inferior Outcomes after Meniscus Repair in Young Patients With Medicaid versus
Patrick A Massey1, Margaret Boston, Tara Saxena
1From the Department of Orthopaedic Surgery (Dr. Massey, Dr. Saxena, Dr. Rutz, Dr. Fincher, Verma), Louisiana State University Health Sciences Shreveport, Shreveport, LA, and the School of Medicine (Dr. Boston), Louisiana State University Health Shreveport, Shreveport, LA.
Introduction:
Patient insurance type influences treatment timelines in meniscal injuries. This study assessed differences in time to presentation, time to treatment, and clinical outcomes of meniscal injuries in young patients with Medicaid versus commercial insurance. It was hypothesized that patients with Medicaid would have greater delays in time to presentation and treatment and inferior clinical outcomes.
Methods:
This retrospective cohort investigation included patients ages 21 years and younger who underwent meniscal repair by a single sports medicine surgeon. Demographics, injury specifications, and treatment timelines were analyzed. Preoperative, 3-, 6-, and 12-month postoperative pain, International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores were compared.
Results:
Time to presentation (163 vs 62 days, P = 0.008) and time from injury to surgery (228 vs 111 days, P = 0.006) were markedly increased in the Medicaid group. Pain (0.5 vs 0.3, P = 0.803), IKDC (89.3 vs 93.1, P = 0.060), Lysholm (94.9 vs 95.1, P = 0.576), and Tegner (7.3 vs 7.3, P = 0.977) scores of Medicaid vs commercial patients were similar at 12 months postoperative. Tegner score of the Medicaid group at 12 months postoperative (7.3) was markedly lower than the preinjury average (8.2) (P = 0.024). The 12-month postoperative IKDC score of Medicaid vs commercial patients with ACL and meniscus tears were markedly different (91.8 vs 97.4, P = 0.044).
Conclusion:
Young patients with Medicaid insurance undergo meniscal repair nearly 3 months later than those with commercial insurance, return to preinjury activity levels less frequently, and have lower 12-month IKDC scores with combined ACL and meniscus injury. Once established with an orthopaedic surgeon, patients have similar timelines for surgery. The discrepancy in time from injury to surgery is an inequality that deserves to be addressed.