Comparing ACL Reconstruction Postoperative Outcomes in Medicaid versus Private Insurance Patients: Is There a Difference?

Objectives: There has been growing evidence that insurance status is a major indicator of postoperative outcomes, which has been extensively reported in orthopedic procedures such as shoulder and knee arthroplasty. Patients with Medicaid public insurance had increased complications, longer lengths of stay, and increased costs compared with patients who had private insurance when controlling for demographic characteristics. Our study compared the outcomes of patients with Medicaid insurance with those patients with private commercial insurance who have undergone anterior cruciate ligament (ACL) reconstruction. We hypothesized that patients with Medicaid insurance coverage would have worse patient-reported outcomes and complication rates in comparison with a matched cohort of patients with private insurance.

Methods: Our departmental registry was queried for all patients who underwent primary arthroscopically assisted ACL reconstruction by 10 surgeons in the practice between January 2018 and June 2022 and were at least 2 years out from their surgery. Eligible patients in the matched cohort model were contacted via telephone for consent to participate in this study and questioned about their pain level, return to sport, physical therapy compliance, and any incidence of retear rates or additional procedures in their ipsilateral or contralateral knee. Patients were then compared across insurance types based on Lysholm knee score, as well as the other patient-reported outcomes.

Results: A total of 189 ACL reconstructions were screened during the study period. Fifteen private insurance and 15 Medicaid patients responded to the telephone call and consented to the study. Comparison of the clinical outcomes within the insurance cohorts revealed that there were no significant differences in Lysholm knee scores, pain scores, revision rate, and return to sport. The only significant difference observed was that Medicaid patients had a greater physical therapy compliance rate. Multivariate linear regression analysis revealed that males had the highest odds ratio associated with higher Lysholm scores, but there was no significance observed with any factor.

Conclusions: Although Medicaid patients did have greater physical therapy attendance, this did not improve their postoperative outcomes, which may suggest that Medicaid status may affect physical therapy effectiveness and can be a confounding variable related to other health disparities. Because the multivariate linear regression analysis did not show any associated factors with poorer postoperative outcomes, this may imply that some demographic factors or insurance status may not be contraindications to ACL reconstruction. Despite the lack of significance, males had a greater likelihood of achieving acceptable Lysholm knee scores based on the multivariate analysis.