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J Knee Surg 2023; 36(07): 792-800
DOI: 10.1055/s-0042-1743229
Original Article

Predictors of Disparities in Patient-Reported Outcomes before and after Arthroscopic Meniscectomy

Christopher Bloise 
1   School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
Bronson Fong
1   School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
Kirk Jeffers
2   Department of Sports Medicine, Steadman Hawkins Clinic, Denver, Englewood, Colorado
,
Amy Bronstone 
3   Department of Orthopaedics, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
Claudia Leonardi
4   Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
Todd Veale
1   School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
John Poche
1   School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
,
Vinod Dasa
3   Department of Orthopaedics, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Abstract

The purpose of this study is to identify predictors of disparities in patient-reported outcome measures (PROMs) before and after arthroscopic meniscectomy. Knee injury and Osteoarthritis Outcome Score (KOOS) was used in this study. All patients who underwent single-knee arthroscopic meniscectomy from January 2012 to March 2018 performed by a single surgeon at an academic safety-net hospital were identified. We excluded patients who had undergone ipsilateral previous knee surgery, bilateral meniscectomy, or concomitant ligament, cartilage, or osteotomy procedures, and those with severe radiographic osteoarthritis in the operated knee, missing preoperative data, or military insurance. Data abstracted from medical records included demographics (age, sex, race, insurance type), clinical characteristics (body mass index, Charlson comorbidity index, and Kellgren-Lawrence [KL] grade), procedure codes, and KOOS assessed before and 90 days after surgery. Multivariable analyses investigated the associations between patient characteristics and the KOOS Pain, other Symptoms, and Function in activities of daily living (ADL) subscales. Among 251 eligible patients, most were female (65.5%), half were of nonwhite race (50.2%), and almost one third were insured by Medicaid (28.6%). Medicaid and black race were statistically significant (p < 0.05) predictors of worse preoperative values for all three KOOS subscales. Medicaid insurance also predicted a lower likelihood of successful surgery, defined as meeting the 10-point minimal clinically important difference, for the KOOS symptoms (p < 0.05) and KOOS ADL (p < 0.05) subscales. Compared with patients without definitive evidence of radiographic osteoarthrosis (KL grade 1), those with moderate radiographic osteoarthritis (KL grade 3) were less likely to have a successful surgical outcome (p < 0.05 for all subscales). Worse preoperative KOOS values predicted worse postoperative KOOS values (p < 0.001 for all subscales) and a lower likelihood of surgical success (p < 0.01 for all subscales). Insurance-based disparities in access to orthopaedic care for meniscus tears may explain worse preoperative PROMs and lower success rates of meniscectomy among Medicaid patients. Patients with meniscus tears and radiological and/or magnetic resonance imaging evidence of osteoarthritis should be carefully evaluated to determine the appropriateness of arthroscopic meniscectomy.

Keywords

arthroscopy - knee - meniscus tear - patient-reported outcomes - disparities - insurance - race


Publication History

Received: 27 March 2021

Accepted: 09 January 2022

Article published online:
25 February 2022

© 2022. Thieme. All rights reserved.

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