Abstract
Objectives:
Operative management of patellar instability with medial patellofemoral ligament reconstruction (MPFLR) has been associated with good results, but socioeconomic disparities may be an obstacle to patients receiving timely care and achieving satisfactory outcomes. The purpose of this study was to identify socioeconomic predictors of time to initial evaluation, time to surgery, and postoperative outcomes among lateral instability patients undergoing MPFLR.
Methods:
We conducted a retrospective review of patients at our institution who underwent primary MPFLR with allograft from 2011 to 2019. Patients were administered an email survey to assess symptom history, socioeconomic variables (ex. language, race, ethnicity, marital status, household size), and postoperative outcomes including Visual Analog Scale (VAS) pain, Kujala score, MPFL-Return to Sport After Injury (MPFL-RSI) score, and return to work and sport. Predictors of time to initial evaluation, time to surgery, concomitant procedures, and postoperative outcomes were identified using multivariable linear and logistic regression with stepwise selection. P-values less than 0.05 were considered significant.
Results:
Seventy patients were included in the cohort (mean age 24.8 years, 72.9% female, mean follow- up time 45.7 months). Mean time to evaluation was 6.4 months (range 0-221) and mean time to surgery was 73.6 months (range 0-444). Home ownership was predictive of reduced time to surgery (β: -56.5 [- 104.7 to -8.3]; p = 0.02). Non-white race was predictive of increased odds of undergoing a concomitant procedure (OR: 12.4 [1.8 to 83.4]; p = 0.01). Full-time employment was predictive of higher satisfaction (β: 14.1 [4.3 to 23.9]; p = 0.006) and higher Kujala score (β: 8.7 [0.9 to 16.5]; p = 0.03).
Conclusions:
Certain markers of higher socioeconomic status, including home ownership and full-time employment, were predictive of higher satisfaction and knee function following MPFLR for patellar instability. Non-white race was associated with higher risk of concomitant procedures. Identifying modifiable socioeconomic risk factors for delayed presentation and poorer surgical outcomes may allow surgeons to prioritize earlier intervention among the most vulnerable segments of their patient population.