Language barrier, neighborhood conditions associated with delayed care for ACL injuries in kids and adolescents

December 13, 2022

Young patients’ neighborhood conditions and their preferred language being one other than English, are both associated with a delay between ACL injury and receiving surgical care.

The conclusions are the results of two separate retrospective, comparative studies published in Clinical Orthopaedics and Related Research (CORR) from the Division of Orthopedic Surgery and Sports Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and the Northwestern University Feinberg School of Medicine. 

Timely care after ACL injury is important, as delayed treatment can result in more meniscal or cartilage injury, residual instability, and worse patient-reported outcomes. For the article “Are Neighborhood Conditions Associated with Surgical Delays and Meniscus Tears in Children and Adolescents Undergoing ACL Reconstruction?” researchers examined data from 415 patients 18 years or younger, considering patients with the lowest and highest Child Opportunity Index (COI) scores. The COI is a validated neighborhood-level index score derived from 29 independent indicators that are known to affect children’s health and development. 

Even when controlling for insurance type, patients with low or very low COI scores, or with the poorest neighborhood conditions, were more likely to have surgery more than 60 and 90 days after injury when compared with patients with a high COI score, or the best neighborhood conditions. Furthermore, patients with low or very low COI scores were more likely to have concomitant meniscus tears than those patients with high or very high COI scores. 

Researchers concluded that the COI score can be useful in identifying patients and communities at risk for disparate care after an ACL injury.

“Most previous research on this topic utilizes insurance as a marker for resource limitation,” said Neeraj Patel, MD, MPH, MBS, a co-author of the publications. “However, our results suggest that neighborhood conditions are associated with care disparities even when controlling for insurance and race/ethnicity. This suggests that neighborhood-level interventions may be impactful in providing more equitable care.”

The same group of researchers published a second article, “Is Preferred Language Other Than English Associated with Delayed Surgery After ACL Injury in Children and Adolescents?” establishing an association between delayed surgical care for ACL injury and a preference for a language other than English. 

For this study, the authors considered data from 543 patients treated surgically for ACL injuries. Of these, 21 percent preferred a language other than English, with 94 percent of them preferred Spanish. After controlling for potentially confounding variables like insurance and age, researchers found that patients whose families had a language preference other than English had greater odds of undergoing surgery more than 60 and 90 days after injury. 

The authors concluded that enhanced partnerships with primary care providers, emergency departments, schools and community organizations in areas with a large proportion of families with a language preference other than English could improve efficiency in the care of children with ACL injuries. They also recommend that institutions caring for these patients provide reliable interpreter services and translated reference materials while aiming to train and hire multilingual clinicians. 

“Our recent studies uncover disparities that are fairly new to the literature, but not to our patients,” Dr. Patel said. “The next step is to truly start addressing these problems, which are undoubtedly complex and multifactorial in nature. This is the priority of our team’s future research.”