Social Determinants of Health and Quadriceps Strength Recovery in Children and Adolescents following Anterior Cruciate Ligament Reconstruction

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Background: Social determinants of health (SDOH) contribute to delays in access to care and inferior outcomes following anterior cruciate ligament (ACL) reconstruction. The interplay between multiple SDOH factors has not been investigated in children and adolescents during rehabilitation. Purpose: To assess the relationships between SDOH variables, including demographics, singular surrogate indicators and multivariate indices, and quadriceps strength recovery at time of return-to-play testing following pediatric ACL reconstruction. Study Design: Retrospective Cross-Sectional Study. Methods: Patients who underwent primary ACL reconstruction at a single pediatric tertiary-care center completed a standardized return-to-play battery of tests six months post-operatively. The associations and interactions between SDOH variables and knee extension peak torque limb symmetry index (LSI), obtained during isokinetic testing at 60 °/s, were explored statistically with both univariate and multivariate analyses. Results: Data on 259 White or Black/African American patients (43.2% female, mean age 15.3 ± 2.0 years) were utilized for analyses. Although several SDOH variables were significantly associated with knee extension peak torque LSI in univariate regression analyses, only sex, F (1, 253) = 11.15, p = 0.001, race, F (1, 253) = 12.06, p < 0.001 and their interaction, F (1, 253) = 6.53 , p = 0.011, remained statistically significant when entered in the final general linear model after controlling for age and graft type. Adjusted means (standard errors) for knee extension peak torque LSI were 74.6% (1.9) for White males, 72.8% (2.1) for White females, 72.5% (1.9) for Black or African American males, and 60.5% (2.2) for Black or African American females. Conclusions: Black or African American females demonstrated inferior quadriceps strength recovery six months following pediatric ACL reconstruction. The development of targeted interventions and multicomponent initiatives to reduce combined racial and sex disparities following pediatric ACL reconstruction are warranted to close the gap in pediatric orthopedic care. Level of Evidence: Level 3.

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