Is Preferred Language Other Than English Associated With Delayed Surgery After ACL Injury in Children and Adolescents?

Abstract

BackgroundPrevious studies have investigated the impact of social determinants of health, such as the type of healthcare insurance and household income, on children and adolescents with ACL tears. However, despite the increasing incidence of ACL injury in young patients and a substantial proportion of families who may prefer languages other than English, the relationship between language and clinical care remains unclear.Questions/purposesTo investigate the relationship between language and the care of children and adolescents with ACL tears, we asked: (1) Is a preferred language other than English (PLOE) associated with a delay between ACL injury and surgery? (2) Is a PLOE associated with a greater odds of a patient experiencing a meniscal tear and undergoing a meniscectomy than in those who prefer English?MethodsWe treated 591 patients surgically for ACL injuries between 2011 and 2021. Of those, we considered patients aged 18 years or younger who underwent primary ACL reconstruction for this retrospective, comparative study. Five percent (31 of 591) of patients were excluded because the date of injury was not clearly documented, 2% (11 of 591) were revision reconstructions, and 1% (6 of 591) underwent procedures that were intentionally delayed or staged, leaving 92% (543 of 591) for analysis. The mean age was 16 ± 2 years, and 51% (276 of 543) of patients were boys. The family’s preferred language was noted, as were demographic data, time between injury and surgery, and intraoperative findings. A language other than English was preferred by 21% (113 of 543) of patients. Of these, 94% (106 of 113) preferred Spanish. In a univariate analysis, we used independent-samples t-tests, Mann-Whitney U-tests, and Fisher exact tests, as appropriate. Purposeful-entry multivariable regression analyses were used to determine whether PLOE was associated with increased time to surgery, concomitant meniscus injury, or performance of meniscectomy while adjusting for confounding variables. Variables were included in multivariable models if they met the threshold for statistical significance in univariate testing (p < 0.05).ResultsThe median time between injury and ACL reconstruction was shorter in families who preferred English compared with those with a PLOE (69 days [IQR 80] versus 103 days [IQR 107)]; p < 0.001). After controlling for potentially confounding variables like insurance and age, we found that patients whose families had a PLOE had greater odds of undergoing surgery more than 60 days after injury (OR 2.2 [95% CI 1.3 to 3.8]; p = 0.005) and more than 90 days after injury (OR 1.8 [95% CI 1.1 to 2.8]; p = 0.02). After controlling for insurance, age, and other factors, PLOE was not associated with surgical delay beyond 180 days, concomitant meniscal tears, or performance of meniscectomy.ConclusionIn this study of children and adolescents undergoing primary ACL reconstruction, patients whose families prefer a language other than English experienced a longer delay between injury and surgery. In areas with a large p...

CORR Insights®: Is Preferred Language Other Than English Associated With Delayed Surgery After ACL Injury in Children and Adolescents?

“…This complexity is well illustrated when discussing patient-preferred language. In the present study [3], most (94%) of the patients with a preferred language other than English were Spanish-speaking. To assume a singular experience among Spanish-speaking patients is to neglect important questions about the cause of health disparity.…”

“…The authors of “Is Preferred Language Other Than English Associated With Delayed Surgery After ACL Injury in Children and Adolescents?” took a step in the right direction with their study in this month’s Clinical Orthopaedics and Related Research ® [3]. The authors found that young patients with ACL injuries whose spoken language in the home was other than English were at a higher risk of delayed time from injury to intervention.…”

“…The authors of the present study [3] do a great job identifying the role of community partnership and patient education in their discussion of findings. Where we need to improve is identifying the specific barriers to care that affect individuals of specific communities with a shared lived experience.…”

Disparate Impact: How Does Social Deprivation Affect Patient-reported Outcomes After ACL Reconstruction in Children and Adolescents?

“…A minimal clinically important difference of 3 points was used for each measure. 4,12 The secondary outcomes studied were time to first visit, time to surgery, additional procedures at index surgery, and follow-up length. Additional procedures included those addressing both meniscal and chondral pathology.…”

“…The Patient-reported Outcomes Measurement Information System (PROMIS) 50 Pediatric Version 1 questionnaire was completed by patients at each postoperative visit, and domain scores were generated for physical function/mobility, pain interference, anxiety, fatigue, depression, and peer relationships. A minimal clinically important difference of 3 points was used for each measure 4,12 . The secondary outcomes studied were time to first visit, time to surgery, additional procedures at index surgery, and follow-up length.…”