{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:47:04Z","timestamp":1792068424029,"version":"4.4.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Background:<\/jats:title>\n Delayed anterior cruciate ligament reconstruction (ACLR) in pediatric patients is associated with progressive intra-articular injury. Although disparities in access to orthopaedic care have been reported, it remains unclear whether structural determinants of health influence postpresentation surgical delay and downstream functional recovery.<\/jats:p>\n <\/jats:sec>\n \n Purpose:<\/jats:title>\n To determine whether sociodemographic and structural determinants are associated with prolonged postpresentation delay to pediatric ACLR and with intra-articular injury severity and postoperative functional outcomes.<\/jats:p>\n <\/jats:sec>\n \n Study Design:<\/jats:title>\n Cohort study; Level of evidence, 3.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n The records of 443 pediatric patients who underwent ACLR (2013-2025) at an urban academic referral center with a pediatric orthopaedic urgent care were reviewed. Exposures included race\/ethnicity, insurance type, and neighborhood deprivation (Childhood Opportunity Index [COI]). Delay was defined as time from first orthopaedic presentation to surgery, with prolonged delay defined as >120 days. Outcomes included high-grade cartilage injury (Outerbridge grade 3 or 4), meniscal tear presence, failure to return to sport (\u2265365 days of follow-up), hop test symmetry, isometric strength symmetry, and graft failure. Multivariable regression models were adjusted for race\/ethnicity, age, sex, insurance, and national COI.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The median time from injury to presentation was 5 days, while the median postpresentation time to surgery was 101 days; 38.6% experienced prolonged delay. In adjusted logistic regression, non-Hispanic Black, Hispanic, and other\/unknown race\/ethnicity; public insurance; and lower neighborhood opportunity were each independently associated with prolonged delay. Continuous postpresentation delay was independently associated with increased odds of high-grade cartilage injury (OR, 1.004 per day; 95% CI, 1.000-1.008;\n P<\/jats:italic>\n = .048). Among patients with \u2265365 days of follow-up (n = 228), public insurance was not independently associated with failure to return to sport (OR, 1.69;\n P<\/jats:italic>\n = .398). Among those completing functional testing (n = 150), public insurance (\u03b2 = +9.14;\n P<\/jats:italic>\n = .046), higher national COI (\u03b2 = +0.14 per unit;\n P<\/jats:italic>\n = .045), and male sex (\u03b2 = +9.59;\n P<\/jats:italic>\n = .010) were each independently associated with greater hop test asymmetry, whereas no independent associations were observed for isometric strength symmetry or graft failure.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Disparities in pediatric ACLR are driven primarily by postpresentation system-level delays and are associated with an incrementally greater risk of cartilage injury.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/03635465261469687","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:38:07Z","timestamp":1785757087000},"page":"2668-2679","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sociodemographic Predictors of Postpresentation Delay to Pediatric ACL Reconstruction and Associated Intra-articular Injury Severity"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8896-9857","authenticated-orcid":false,"given":"Christopher D.","family":"Hamad","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3584-6976","authenticated-orcid":false,"given":"Kole","family":"Joachim","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Chung","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA"},{"name":"Luskin Orthopaedic Institute for Children, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Bowen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA"},{"name":"Luskin Orthopaedic Institute for Children, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3401-2355","authenticated-orcid":false,"given":"Soroush","family":"Baghdadi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA"},{"name":"Luskin Orthopaedic Institute for Children, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00852"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2018.11.004"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1877"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000402"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000706"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513518412"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519849695"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231216364"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221126506"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1802313"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511420818"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967114548176"},{"key":"e_1_3_2_14_2","unstructured":"Noelke C McArdle N DeVoe B et al. 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