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

IF 2.5 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-07-21 eCollection Date: 2025-07-01 DOI:10.1177/23259671251336395
Rithika Ginjupalli, Endel J Orav, Nadine J McCleary, Harrison T Hubbell, Miho J Tanaka
{"title":"Clinical and Social Predictors of Surgical Treatment for Anterior Cruciate Ligament Injuries.","authors":"Rithika Ginjupalli, Endel J Orav, Nadine J McCleary, Harrison T Hubbell, Miho J Tanaka","doi":"10.1177/23259671251336395","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Purpose: </strong>To report on clinical and social predictors of surgical versus nonsurgical treatment in patients with ACL injuries and quantify the influence of each factor.</p><p><strong>Study design: </strong>Case control study; Level of evidence, 3.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 [<i>P</i> < .001] and -2.0 [<i>P</i> < .001], respectively) at the time of initial evaluation. Older age (<i>P</i> < .001), greater body mass index (<i>P</i> = .014), greater comorbidities (<i>P</i> < .001), smoking (<i>P</i> = .06), and subsidized insurance (<i>P</i> < .001) were negative predictors of surgery.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251336395"},"PeriodicalIF":2.5000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280533/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedic Journal of Sports Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23259671251336395","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: 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.

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

Study design: Case control study; Level of evidence, 3.

Methods: 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.

Results: 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.

Conclusion: 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.

前交叉韧带损伤手术治疗的临床和社会预测因素。
背景:虽然前交叉韧带(ACL)损伤在年轻、活跃人群中通常采用手术治疗,但在老年人中可能会考虑非手术治疗。成人的手术决策通常基于患者的偏好、功能残疾水平和合并症的存在。了解临床预测因素在手术决策中的作用可以帮助确定治疗结果的差异。目的:报告前交叉韧带损伤患者手术与非手术治疗的临床和社会预测因素,并量化每个因素的影响。研究设计:病例对照研究;证据水平,3。方法:对诊断为前交叉韧带损伤的患者和随后在单一中心进行前交叉韧带重建的患者进行鉴定。使用患者报告的结果测量评分来确定功能残疾,包括诊断90天内和手术前的膝关节损伤和骨关节炎结果评分物理功能简表(KOOS-PS)和患者报告的结果测量信息系统物理功能(promisf - pf)。收集临床和社会人口学因素,并使用Charlson共病指数记录合并症。进行Logistic回归分析以确定临床和社会人口学因素与前交叉韧带损伤手术可能性之间的关系。结果:共确诊前交叉韧带撕裂3656例;女性1734例(47.4%),平均年龄34.9岁;SD, 13.8岁)和1922(52.6%)为男性(平均年龄32.8岁;SD, 13.1岁)。总体而言,53.8%的女性患者和53.4%的男性患者接受了手术治疗。女性在初始评估时的KOOS-PS和PROMIS值较男性低(分别为-4.1 [P < .001]和-2.0 [P < .001])。年龄较大(P < .001)、体重指数较大(P = .014)、合并症较多(P < .001)、吸烟(P = .06)和补贴保险(P < .001)是手术的负向预测因素。结论:年龄大、体重指数高、合并症多、吸烟和补贴保险是前交叉韧带损伤手术治疗的负面预测因素。临床预测指标在突出差异和理解患者ACL重建决策方面是有用的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信