Child Opportunity Index 3.0 and Insurance Type Do Not Impact Timely Access to Surgery for Pediatric Osteochondral Defects of the Knee.

BACKGROUND

This study aimed to evaluate the impact of socioeconomic status (SES), as measured by Child Opportunity Index (COI) 3.0 and insurance type, on access to orthopaedic care among pediatric patients with osteochondral defects (OCDe) of the knee. A secondary aim was to determine whether delays in care were associated with differences in lesion severity or return-to-sport (RTS) outcomes.

METHODS

We conducted a retrospective cohort study of 109 patients aged 21 years or younger who underwent surgery for knee OCDe between 2012 and 2023 at a tertiary academic center. Demographic and clinical variables were extracted from the chart review. The time interval between injury to diagnosis was categorized as prompt (30 d or fewer) or delayed (more than 30 d). COI 3.0 scores, including total and domain-specific scores for education, health, and SES, were assigned using patient zip codes and stratified into quintiles. χ 2 and the Fisher exact tests were used to assess associations between SES indicators and time to care.

RESULTS

The cohort (mean age 16.1±2.6 y) was predominantly male (64.2%), Spanish/Hispanic/Latino (52.6%), and publicly insured (62.0%), with 75.2% residing in low or very low total COI neighborhoods. Neither insurance type nor COI scores were associated with delayed care. There were also no significant differences in lesion size, ligament injury, or RTS outcomes between prompt and delayed groups at an average follow-up of ∼1.5 years.

CONCLUSIONS

In this predominantly minority and socioeconomically disadvantaged cohort, neither lower COI scores nor public insurance were associated with delayed orthopaedic care for OCDe of the knee. Delays in care did not impact lesion severity or short-term RTS outcomes. Institutional and community-level factors may have mitigated traditional barriers to access in this safety-net pediatric setting.

LEVEL OF EVIDENCE: Level III.