Health disparities in the management of ACL injuries: How socioeconomic status, insurance, and race influence care.

Health care disparities and racial health inequities significantly influence health care delivery and patient outcomes, including for people with injuries of the anterior cruciate ligament (ACL). This narrative review explores factors that may influence the management of ACL injuries. Studies that have discussed potential social barriers to treatment such as socioeconomic status (SES), insurance status, educational level, and cost of treatment were identified by searching databases such as EBSCO Host, PubMed, and Galileo for the index years from 2008 to 2020. The influence of health care inequities on ACL injury management was explored. Twelve studies met inclusion criteria and described a total of 219,708 participants. Barriers to surgical management of ACL injury were higher cost of surgery, greater time to evaluation and treatment, lower SES, lack of private insurance, and being identified as a racial minority. In addition, surgical environment, whether within a private or community-based health care system, and access to care affected post-surgical complication rates. Finally, risk of revision, lack of physical therapy access, and odds of additional injuries to include chondral and meniscal derangement were higher in racial minority, lower SES, and government insurance populations. These findings suggest health disparity and inequity exist in the care of ACL injury for patients with lower SES and without commercial insurance, and in minority populations. These patients appear to have a significantly reduced ability to access timely care, which can impact healing and ability to return to preferred activities of daily life or sport.

Do Normative Composite Scores on the Functional Movement Screen Differ Across High School, Collegiate, and Professional Athletes? A Critical Review.

OBJECTIVE: The Functional Movement Screen (FMS) is a battery of 7 unloaded tests designed to rate human movement competency. Injury rates vary across the different level of a sport. The purpose of this critical review was to determine whether normative FMS composite scores differ across high school, collegiate, and professional athletic populations and to determine whether normative composite scores correlate with rates of severe injury across different collegiate sports. DATA SOURCES: PubMed, Web of Science, and EBSCO databases from inception to September 2017 with the following syntax: "functional movement screen*" OR "movement screen*". Additional records were identified by citation tracking and hand search of articles. STUDY SELECTION: A total of 708 records identified, of which 36 were included. Studies were included if they reported a FMS composite score for one of the groups. DATA EXTRACTION: Two reviewers (T.R.P. and F.K.) screened records for the author and year; sample size; study design; sport(s); number, age, and sex of participants; testing conditions; methodological quality; and mean or median composite score(s). DATA SYNTHESIS: Normative FMS composite scores were invariant to level of play, with 61% of reported scores falling between 14 and 16, despite injury rates increasing by level of play. Scores for high school, college, and professional athletes were 14.1, 14.8, and 15.7, respectively. There was a significant positive relationship between composite scores and rate of severe injury in college sports (r(11) = 0.66, P = 0.014). CONCLUSIONS: Our findings potentially undermine the FMS's predictive validity. Although the FMS may have other applications, this critical review provides further evidence against the composite score for injury prediction in competitive athletes.