JAAOS - 2026-06-01 - Journal Article
Insurance Type Matters Most: An Analysis of Risk Factors for Poor Physical Therapy Adherence After Anterior Cruciate Ligament Reconstruction in an Urban Population.
Hanelin DG, Volaski HA, Lo Y, Chan FJ, Voleti PB, Levy BJ
Topics
Key Takeaway
Government-sponsored insurance was the only independent risk factor for poor PT adherence after ACLR (P=0.006), with 35.9% of patients missing >15% of sessions despite 93% believing PT was necessary.
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Summary
This study quantified PT adherence barriers in 128 consecutive ACLR patients at a single urban academic center using a 3-month postoperative questionnaire. Government-sponsored insurance independently predicted poor adherence (P=0.006), while ADI, non-English primary language, and lack of car ownership did not. Time commitments (58.6%), transportation (50%), and appointment availability (46.1%) were the most frequently cited barriers, yet 93% of patients endorsed PT as necessary.
Key Limitation
Single-center urban academic cohort of only 128 patients limits generalizability to suburban, rural, or privately insured-majority practices where insurance distribution and PT access infrastructure differ substantially.
Original Abstract
INTRODUCTION
Physical therapy (PT) after anterior cruciate ligament (ACL) reconstruction is critical for recovery. Despite this, adherence to PT protocols remains inconsistent, and although socioeconomic barriers are thought to influence PT attendance, there are a paucity of data quantifying compliance rates and the influence of these proposed barriers.
METHODS
A total of 128 consecutive patients who underwent ACL reconstructions between January 2023 and December 2024 at a single urban academic medical center were studied. Three months postoperatively, patients completed a questionnaire regarding their PT compliance. Demographic, socioeconomic, and behavioral factors were collected.
RESULTS
35.9% of patients missed >15% of sessions. Reported barriers included time commitments (58.6% of respondents), transportation (50%), appointment availability (46.1%), cost (36.7%), and insurance issues (21.9%). Despite difficulties, 93.0% of patients thought PT was necessary. Government-sponsored insurance was associated with poor PT adherence ( P = 0.006). By contrast, historically described barriers to healthcare access, including Area Deprivation Index (ADI) ( P = 0.195), primary language other than English ( P = 1.0), and lack of car ownership ( P = 0.690), were not associated with poor attendance.
CONCLUSION
Having state-sponsored/government-sponsored insurance is an independent risk factor for poor PT adherence, despite near unanimous strong desire of patients to attend therapy. Previously described barriers including higher ADI, primary language other than English, and not owning a car were not notable risk factors.