Background 

Previous studies have investigated the impact of social determinants of health, such as the type of healthcare insurance and household income, on children and adolescents with ACL tears. However, despite the increasing incidence of ACL injury in young patients and a substantial proportion of families who may prefer languages other than English, the relationship between language and clinical care remains unclear.

Questions/purposes 

To investigate the relationship between language and the care of children and adolescents with ACL tears, we asked: (1) Is a preferred language other than English (PLOE) associated with a delay between ACL injury and surgery? (2) Is a PLOE associated with a greater odds of a patient experiencing a meniscal tear and undergoing a meniscectomy than in those who prefer English?

Methods 

We treated 591 patients surgically for ACL injuries between 2011 and 2021. Of those, we considered patients aged 18 years or younger who underwent primary ACL reconstruction for this retrospective, comparative study. Five percent (31 of 591) of patients were excluded because the date of injury was not clearly documented, 2% (11 of 591) were revision reconstructions, and 1% (6 of 591) underwent procedures that were intentionally delayed or staged, leaving 92% (543 of 591) for analysis. The mean age was 16 ± 2 years, and 51% (276 of 543) of patients were boys. The family’s preferred language was noted, as were demographic data, time between injury and surgery, and intraoperative findings. A language other than English was preferred by 21% (113 of 543) of patients. Of these, 94% (106 of 113) preferred Spanish. In a univariate analysis, we used independent-samples t-tests, Mann-Whitney U-tests, and Fisher exact tests, as appropriate. Purposeful-entry multivariable regression analyses were used to determine whether PLOE was associated with increased time to surgery, concomitant meniscus injury, or performance of meniscectomy while adjusting for confounding variables. Variables were included in multivariable models if they met the threshold for statistical significance in univariate testing (p < 0.05).

Results 

The median time between injury and ACL reconstruction was shorter in families who preferred English compared with those with a PLOE (69 days [IQR 80] versus 103 days [IQR 107)]; p < 0.001). After controlling for potentially confounding variables like insurance and age, we found that patients whose families had a PLOE had greater odds of undergoing surgery more than 60 days after injury (OR 2.2 [95% CI 1.3 to 3.8]; p = 0.005) and more than 90 days after injury (OR 1.8 [95% CI 1.1 to 2.8]; p = 0.02). After controlling for insurance, age, and other factors, PLOE was not associated with surgical delay beyond 180 days, concomitant meniscal tears, or performance of meniscectomy.

Conclusion 

In this study of children and adolescents undergoing primary ACL reconstruction, patients whose families prefer a language other than English experienced a longer delay between injury and surgery. In areas with a large proportion of families with a PLOE, partnerships with primary care clinicians, emergency departments, schools, athletic teams, and community organizations may improve efficiency in the care of children with ACL injuries. Clinicians proficient in other languages, reliable interpreter services, and translated references and resources may also be impactful. Our results suggest a need for further research on the experiences, needs, and long-term outcomes of these patients, as well as the association of preferred language with results after surgery.

Level of Evidence 

Level III, therapeutic study.

中文翻译：

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英语以外的首选语言是否与儿童和青少年 ACL 损伤后延迟手术有关？

 背景

先前的研究调查了健康的社会决定因素（例如医疗保险类型和家庭收入）对患有 ACL 撕裂的儿童和青少年的影响。然而，尽管年轻患者中 ACL 损伤的发生率不断增加，而且很大一部分家庭可能更喜欢英语以外的语言，但语言与临床护理之间的关系仍不清楚。

 问题/目的

为了调查语言与 ACL 撕裂儿童和青少年的护理之间的关系，我们提出了以下问题：(1) 除英语 (PLOE) 之外的首选语言是否与 ACL 损伤和手术之间的延迟相关？ (2) 与喜欢英语的患者相比，PLOE 与半月板撕裂并接受半月板切除术的患者的可能性更大吗？

 方法

2011 年至 2021 年间，我们对 591 名 ACL 损伤患者进行了手术治疗。在这项回顾性比较研究中，我们考虑了在这些患者中接受初次 ACL 重建的年龄为 18 岁或以下的患者。 5%（591 名中的 31 名）患者因受伤日期未明确记录而被排除，2%（591 名中的 11 名）进行了翻修重建，1%（591 名中的 6 名）接受了故意延迟或分期的手术，从而导致92%（591 中的 543）用于分析。平均年龄为 16 ± 2 岁，51% 的患者（543 名患者中的 276 名）是男孩。记录了家人的首选语言、人口统计数据、受伤和手术之间的时间以及术中发现。 21% 的患者（543 名患者中的 113 名）更喜欢英语以外的语言。其中，94%（113 人中的 106 人）更喜欢西班牙语。在单变量分析中，我们酌情使用独立样本 t 检验、Mann-Whitney U 检验和 Fisher 精确检验。采用有目的的多变量回归分析来确定 PLOE 是否与手术时间延长、伴随的半月板损伤或半月板切除术的表现相关，同时调整混杂变量。如果变量满足单变量测试中统计显着性的阈值（p < 0.05），则变量被包含在多变量模型中。

 结果

与 PLOE 家庭相比，喜欢英语的家庭受伤和 ACL 重建之间的中位时间更短（69 天 [IQR 80] vs 103 天 [IQR 107]）； p < 0.001）。在控制了保险和年龄等潜在混杂变量后，我们发现家庭有 PLOE 的患者在受伤后 60 天以上接受手术的可能性更大（OR 2.2 [95% CI 1.3 至 3.8]；p = 0.005）等等受伤后 90 天以内（OR 1.8 [95% CI 1.1 至 2.8]；p = 0.02）。在控制保险、年龄和其他因素后，PLOE 与手术延迟超过 180 天、伴随的半月板撕裂或半月板切除术无关。

 结论

在这项针对接受初级 ACL 重建的儿童和青少年的研究中，家庭喜欢英语以外的语言的患者在受伤和手术之间经历了更长的延迟。在 PLOE 家庭比例较高的地区，与初级保健临床医生、急诊科、学校、运动队和社区组织的合作可以提高 ACL 损伤儿童的护理效率。精通其他语言的临床医生、可靠的口译服务以及翻译的参考资料和资源也可能产生影响。我们的结果表明需要进一步研究这些患者的经历、需求和长期结果，以及首选语言与手术后结果的关联。

 证据水平

III级，治疗研究。