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Public Insurance Is Associated with Delays to Surgery in Pediatric Patients with a First-Time Patellar Dislocation Involving a Loose Body

Year: 2026

Type: article

Abstract: First-time patellar dislocations with a loose body require prompt operative treatment to prevent further intra-articular damage. Social determinants and demographic characteristics have been associated with delays in pediatric orthopedic injuries requiring less urgent interventions. The purpose of this study was to examine the impact of demographic factors on surgical timing for children with first-time patellar dislocations involving a loose body. This is a retrospective comparative study of patients <19 years of age undergoing surgery for a first-time patellar dislocation with a loose body or unstable osteochondral fracture at two urban tertiary children’s hospitals between 2007 and 2021. Patients with an underlying genetic syndrome, neuromuscular condition, or recurrent instability were excluded. Demographic data included age, sex, race, ethnicity, and insurance. Clinical data was also collected, with attention to timing between injury and surgery. Univariable analysis was followed by multivariate regression. Odds ratios are reported with 95% confidence intervals (CI). A total of 163 patients met study inclusion criteria (mean age 14.7 ± 2.4 y, 55.3% girls). The median time between injury and surgery for patients with public insurance was 55 days (interquartile range, IQR, 204 d) compared to 38.5 days (IQR 55 d) for those with private insurance (p=0.005). Compared to privately insured children, a higher proportion of those with public insurance had surgery beyond 30 days after injury (80.4% vs. 63.7%, p=0.04). Patients who underwent fixation of their loose body had surgery a median of 33 days after injury (IQR 30 days), while those who underwent removal had surgery 48.5 days after injury (IQR 69 days, p = 0.04). In regression analysis, children with public insurance had 2.3 times higher odds of undergoing surgery later than 30 days after injury (95% CI 1.1-5.2, p=0.04). Each year of increasing age was associated 1.2 times higher odds of surgery beyond 30 days post-injury (95% CI 1.0, 1.4, p=0.02). Time to surgical intervention in pediatric patients with first-time patellar dislocations involving a loose body was significantly delayed in older children and those with public insurance. Delayed surgery is associated with a lower likelihood of osteochondral fixation. Identifying the underlying mechanisms of these disparities can facilitate more equitable care for pediatric patients with patellar instability. Level III. (1) Public insurance is associated with longer delays to surgery for pediatric patients with a first-time patellar dislocation involving a loose body. (2) Older age is independently associated with delayed surgical intervention in this patient population. (3) Delayed treatment for these injuries lowers the likelihood of osteochondral fixation. (4) Identifying and addressing disparities is necessary to promote equitable pediatric orthopaedic care.

Source: Journal of the Pediatric Orthopaedic Society of North America

DOI: 10.1016/j.jposna.2026.100327