Thanks, Ted. Thanks to AOSSM for this opportunity. Many thanks to my co-authors for all their hard work, and a special thanks to the Broadmoor for being a great host. Here are our disclosures. Nothing relevant except that this has been accepted for publication in AJSM. As we know, there's been an increase in sports participation in pediatric and adolescent populations. Likewise, we've seen a rate of ACL reconstruction increasing over time, as MinnKoker has shown. What we asked in this study is, has the rate of concomitant procedures in association with ACL reconstruction increased? And if so, what are the contributing factors? The hypothesis being age, gender, race, ethnicity, income, or insurance status may affect the rate of concomitant meniscus procedures in association with ACL reconstruction. We know that patients with public insurance face barriers in access to sports medicine and orthopedic services. This results in delayed presentation and time to surgery. In patients with isolated meniscus tears, it's been shown that being female, non-white race, or having non-private insurance were associated with lower rates of meniscus surgery. We utilized the Pediatric Health Information System, or PHIS for short, which is a database that contains inpatient, ED, and ambulatory surgery data from 52 pediatric hospitals in the U.S. We used 39 of these 52 hospitals' data based on the completeness of their data sets over the time period. Patients 18 years of age or younger were stratified by age, sex, race, ethnicity, insurance type. They were also stratified by mean household income and their rural or urban areas. We did linear and logistic regression analysis. From 2015 to 2019, we saw 14,000 ACL reconstructions. This increased, as you would expect, 1.15-fold over that time. We saw that in these ACL reconstructions, over 8,000 of them, or 58%, had a concomitant meniscus procedure. This increased 1.2-fold over this time period. Of those 8,000 that underwent ACL reconstruction with a meniscus procedure, 46% had a meniscectomy, which actually decreased over time, and 54% had a meniscus repair, which increased 1.7-fold over time. So that's a trend we would expect to see in this young population. We found that increased odds of a concomitant meniscus procedure were found in association in ACL reconstruction if the patients were male, older age, black race, Hispanic ethnicity, lived in an urban area, or had public or other insurance, basically non-private insurance. They also had an increased odds of having a meniscectomy over a repair if they were non-white race or had public or other insurance. Again, there are limitations of these large administrative databases. We had lack of access to their medical records and outpatient data, and it only represents trends at tertiary care referral pediatric hospitals. But this does include private and public insurance data, which is not always available in other large insurance-based databases. And this looks at trends over a limited time frame, which was five years. So in conclusion, we've seen that there's a rise in the number of concomitant meniscus procedures in association with ACL reconstruction in this young patient population. There's been a rise in meniscus repair versus meniscectomy, but there's also been an increased odds of getting a meniscectomy over a repair if you were non-white and if you had public or other insurance. Again, this identifies potential access and equity issues in pediatric and adolescent patients undergoing ACL reconstruction. It takes an amazing team to pull this off, and so I want to thank them, Alana Feldman, who's our database guru, Ryan Coney, who's our research coordinator, Danielle Cook, who's a biostatistician for us in our department, and Angela Mercurio, who's a Harvard medical student and a superstar, and you'll be seeing her up on this podium for the Society in the Future.

sports participation

ACL reconstruction surgeries

pediatric population

concomitant procedures

access issues