questions, please make your way to the microphone and we can take questions and also be sure to send anything to the chat for questions that you might have. So first question. So for William, did you modify the rehabilitation for these patients following the procedure compared to your standard meniscus repairs or ACL reconstruction patients? So I believe all patients, regardless of the reconstruction type, followed the same protocol that's been consistent throughout the MOON trials. I don't think it was modified for this particular study, yeah. Is there someone at the microphone? Oh, yeah. Joe Nguyen from HSS. This one's for Dr. Abello. Wonderful study about your SES findings. You've had some interesting findings about the ADI and the Medicaid on the outcomes that you presented. But I was just wondering, because the Medicaid data is individual-level data and the ADI is community-level data, did you somehow also control for any potential biases looking at community-level data relative to the individual level because you're just applying it to there and there may be some biases that occur by putting that to every patient in that group? Right, that's a great point. Actually for the Medicaid, our system is a first-come, first-served basis. So I think that's one of the reasons we didn't see the difference in Medicaid patients because we're basically just seeing them as they come in rather than just bumping them and delaying their surgery. It's not like an internal triage thing. So I think that might be one of the reasons that Medicaid insurance did not have the same effect of the ADI in terms of delaying of care and time from injury to surgery. Thanks. Do we have a question here? Yes, Kevin Shea, Stanford, for Dr. Abello and all the authors. Great session and presentations. Dr. Abello, your comment about Medicaid higher injury rates, we have over the last year looked at physical therapy access for ACL patients. We see about 45% Medicaid, 45, 50%, so we actually have a higher percentage than you, but less than 12% of the physical therapy clinics in the area which our Medicaid population live actually will see Medicaid patients. So basically 88% of them can't get therapy. There's two clinics, Stanford and UCSF in the Bay Area that will see Medicaid patients for ACL. Do you think the absence of access to good rehab may be an issue and might explain why the ACL injury rates are higher in that population even though they have good access for care? Absolutely. I think there's a good study in 2018 by Rogers that basically shows that same thing that 43% of clinics, few clinics, actually accept Medicare. So I think it's just an access after surgery. They're not getting the same access as commercial insurance. And that's, as we know, that's super important in terms of outcomes after an ACL surgery. Is there anything on the end? We have time. Yeah. So to that, so we've done a lot of work looking at racial disparities and access to care and really found that the socioeconomic piece was the most important piece. So poor black patients do the same as poor white patients and vice versa. Any other factors that you think kind of come into play because actually our Medicaid patients they have unlimited PT visits it seems like and a lot of access to PT, but there's some other factor I think at play when you look at this. Yeah. I mean, I think it's hard to tell. It's a very complex problem, but definitely social support. Some of them have to go back to work like after surgery. I think that's one of the things that may be different, but definitely hard to pinpoint the exact point for that exact variable that actually it's causing that they do worse than the other patients. And other things like maybe health literacy and things like that sort of, I think are all kind of important factors that play for this. Thank you. Thank you. I'd like to thank all the speakers and my co-moderator Latul.

patient rehabilitation

access to care

Medicaid

injury rates

health literacy