title: Influence of Health Insurance Status on the Timing of Surgery and Treatment of Bucket-Handle Meniscus Tears.
abstract: BACKGROUND
  Lack of insurance has been shown to lead to delays in seeking care as well as fewer preventive medicine visits and poorer overall health status.
  
  
  OBJECTIVE
  To investigate the effects of insurance status on the timing and treatment of patients with bucket-handle meniscus tears.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Charts from 2004 to 2013 were retrospectively reviewed for patients diagnosed with bucket-handle meniscus tears. Patients were divided into 2 groups: insured or underinsured. The insured group included patients with commercial insurance or Medicare. The underinsured group included patients with Medicaid or Charity Care. Time intervals were categorized as <6 weeks or ≥6 weeks.
  
  
  RESULTS
  A total of 52 patients were included in this study: 15 (29%) insured and 37 (71%) underinsured. Underinsured patients experienced delays in initial presentation to an orthopaedic surgeon (P = .004), time from magnetic resonance imaging to surgery (P = .01), and time from injury to surgery (P = .007). Repair rates were 40% and 38% (P > .999) for the insured and underinsured, respectively. Repair rates for <6 weeks from injury to surgery were 75% for insured (P = .007) and 100% for underinsured patients (P = .001). Repair rates for ≥6 weeks from injury to surgery were 0% for insured and 30% for underinsured patients. Overall, patients with an injury-to-surgery time of <6 weeks had a significantly higher repair rate (87%) than those managed >6 weeks (19%) (P < .001).
  
  
  CONCLUSIONS
  Underinsured patients experience significant delays in time to presentation and overall time to surgery. However, the overall repair rate between the insured and underinsured is similar. Regardless of insurance status, patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks.
  
  
  CONCLUSIONS
  Patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks.
authors.affiliation: Shoulder and Elbow Surgery Fellow, Harvard Boston Shoulder Institute, Boston, Massachusetts, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA.
authors.forename: Guillem
authors.initials: G
authors.lastname: Gonzalez-Lomas
authors.affiliation: North Jersey Orthopaedic Group, Wayne, New Jersey, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Gehrmann
keywords: bucket handle; insurance; meniscus; timing