Social Determinants of Health and Quadriceps Strength Recovery in Children and Adolescents following Anterior Cruciate Ligament Reconstruction.
Victor V Prati, Beverly J Spray, Cody W Walker and 4 others
PMID 40322519WHAT IT FOUND
Black or African American girls recovered significantly less quadriceps strength than boys or White patients after ACL reconstruction.
Neighborhood deprivation indices lost their statistical significance once age and graft type were accounted for.
Key findings
01Only sex, race, and their interaction remained statistically significant predictors of quadriceps strength recovery after controlling for age and graft type.
02Black or African American females had a significantly lower knee extension peak torque limb symmetry index compared to Black or African American males and White patients.
03Multivariate social determinants of health indices (ADI, SDI, COI) were no longer statistically significant when entered into a model with graft type and age included as covariates.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was retrospective, which introduces potential bias and confounding variables. All participants were treated at a single pediatric center by one surgeon, limiting the generalizability of the findings to other settings. The analysis excluded Hispanic patients and those who did not designate a race, restricting the applicability of the results to non-Hispanic Black and White populations. The study relied on electronic medical record data for race and sex, which may not fully capture the complexity of social constructs or identity. Quadriceps strength was the only outcome measured; other factors like return-to-sport rates and re-injury risk were not assessed.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the loss of significance for neighborhood deprivation indices as evidence that social factors do not matter. The study design cannot establish causality, and the exclusion of Hispanic participants limits the generalizability of the racial findings.