title: Does Racial Variation Influence Preoperative Characteristics and Intraoperative Findings in Patients Undergoing Anterior Cruciate Ligament Reconstruction?
abstract: BACKGROUND
  A limited number of large multiethnic cohorts of patients undergoing anterior cruciate ligament reconstruction (ACLR) exist; therefore, little is known about racial differences in preoperative and intraoperative characteristics of patients undergoing this procedure.
  
  
  OBJECTIVE
  To evaluate preoperative patient, surgeon, and hospital characteristics and intraoperative findings associated with various patient races undergoing ACLR.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A cross-sectional study of patients undergoing primary ACLR (performed between January 1, 2008 and September 30, 2012) was conducted. The Kaiser Permanente ACLR Registry was used to identify the cases and variables for the study. The variables of age, sex, time from injury to surgery, body mass index, sport at the time of injury, concomitant injury (menisci, cartilage, other ligament), surgeon training, and surgeon and site volumes were evaluated. Race was categorized into white (reference), Hispanic, Asian, and black. Polychotomous regression models were employed. Odds ratios (ORs) and 95% CIs are provided.
  
  
  RESULTS
  A total of 14,278 ACLRs were evaluated; there were 7401 (51.8%) ACLRs performed on white, 3912 (27.4%) on Hispanic, 1894 (13.3%) on Asian, and 1071 (7.5%) on black patients. Men predominated overall as well as in each of the race categories. Compared with white patients, after adjusting for all covariates, Asian (OR, 1.24; 95% CI, 1.10-1.40) and Hispanic (OR, 1.52; 95% CI, 1.39-1.67) patients undergoing ACLR were more likely to be male than female, and black patients were more likely to be female (OR, 0.69; 95% CI, 0.60-0.80). All racial groups tended to undergo ACLR in younger age bands compared with white patients, with black patients having the highest odds of being < 17 years (OR, 2.74; 95% CI, 2.23-3.37) and 17 to 24 years of age (OR, 2.28; 95% CI, 1.94-2.68) compared with being ≥ 25 years. Asian patients were more likely injured playing basketball (OR, 4.31; 95% CI, 3.67-5.06), black patients during football (OR, 3.48; 95% CI, 2.73-4.45) and basketball (OR, 5.52; 95% CI, 4.49-6.78), and Hispanic patients during soccer (OR, 3.09; 95% CI, 2.75-3.48). Hispanic patients had a higher likelihood of having both menisci injured at the time of surgery (OR, 1.31; 95% CI, 1.16-1.49) as well as the lateral meniscus (OR, 1.31; 95% CI, 1.17-1.47). Asian patients had a lower likelihood of cartilage injuries (OR, 0.78; 95% CI, 0.68-0.88). Sports medicine fellowship-trained surgeons were more likely to have operated on black (OR, 1.27; 95% CI, 1.07-1.51) and Hispanic (OR, 1.16; 95% CI, 1.04-1.29) patients.
  
  
  CONCLUSIONS
  In this large representative sample of patients undergoing ACLR in the United States, 48.2% of the cohort was nonwhite, and racial variations in sex, age, sport at injury, and intraoperative findings at ACLR were identified. Understanding the differences in ACL injury presentation and concomitant injuries by race can be useful in helping tailor the development of an ACL injury prevention program, during the informed consent process, and in the arthroscopic portion of the procedure according to patient race-specific characteristics.
authors.affiliation: Department of Orthopaedic Surgery, Kaiser Permanente South Bay, Harbor City, California, USA ronald.a.navarro@kp.org.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Navarro
authors.affiliation: Surgical Outcomes & Analysis Unit, Southern California Permanente Medical Group (SCPMG) Clinical Analysis Department, San Diego, California, USA.
authors.forename: Maria C S
authors.initials: MC
authors.lastname: Inacio
authors.affiliation: Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park, Baldwin Park, California, USA.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Maletis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: anterior cruciate ligament reconstruction; concomitant injury; race