ArticleOrthopaedic journal of sports medicine2026
Insurance Type as an Independent Factor of Surgical Delay After Anterior Cruciate Ligament Injury.
Article in Orthopaedic journal of sports medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) is time-sensitive, as surgical delays exceeding 120 days are associated with an increased risk of secondary meniscal injury. Insurance type is a known determinant of health care access; however, its specific impact on time to ACLR is poorly characterized. Purpose: To determine the effect of insurance type on the known increased risk of surgical delay >120 days in patients undergoing ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A dual-center retrospective cohort study was conducted, including 2030 patients (age, 9-73 years) who underwent primary ACLR between 2013 and 2023 at 2 centers. Patients were stratified by insurance type: private (n = 1619), public (n = 362), self-pay (n = 27), and workers' compensation (n = 22). The primary outcome was surgical delay, defined as >120 days from injury to surgery. This threshold was selected a priori based on institutional data linking this threshold to increased risk of secondary meniscal injury. Multivariable logistic regression, including 2008 patients (private, public, and self-pay), was used to estimate adjusted odds ratios (aORs) with 95% CIs for the risk of delay. The model compared patients with public insurance and self-pay status to those with private insurance (the reference group) and was adjusted for confounding effects of patient age, biological sex, and injury type (sports-related vs nonsports-related). The multivariable logistic regression was restricted to patients with private, public, and self-pay insurance; the workers' compensation cohort was omitted from this analysis due to sample size considerations. Results: Descriptive statistics revealed substantial differences in median wait times by insurance type: privately insured patients (median, 55 days [interquartile range, IQR, 90.5]), publicly insured patients (median, 106 days [IQR, 247]), self-pay patients (median, 145 days [IQR, 420]), and workers' compensation (median, 97.5 days [IQR, 136]). Multivariable logistic regression confirmed that insurance type was a significant Conclusion: This study demonstrates that insurance status is a significant independent
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