804 - Socioeconomic Disparities in Pediatric PM&R Adherence After Knee Injury

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

GP

Gabriella Perez-Lago, BA

Medical Student (M2)
FIU Herbert Wertheim College of Medicine
Miami, Florida, United States

Co-Author(s)

JG

Joshua Gershenson, BS

Medical Student (Year 2)
FIU HWCOM
Sunny Isles, Florida, United States
JM

Jason Mirharooni, BA

Medical Student
Florida Internation University Herbert Wertheim College of Medicine
Los Angeles, California, United States
JK

Joshua Khorsandi, BS

Medical Student
Kirk Kerkorian School of Medicine at University of Nevada Las Vegas
Las Vegas, Nevada, United States
WK

William A. Kunkle, DO

Orthopedic Spine Surgeon
Florida Spine Associates
Boca Raton, FL, Florida, United States

Submitter(s)

GP

Gabriella Perez-Lago, BA

Herbert Wertheim College of Medicine
Miami, Florida, United States

Objectives: Adolescents who sustain traumatic knee injuries such as ACL tears, patellar dislocations, and meniscal injuries often need structured physical medicine and rehabilitation (PM&R) to recover function and return to sports. Adherence to therapy is variable, and socioeconomic status (SES) plays a role. This review summarizes evidence on how SES impacts adherence to PM&R and physical therapy in this population and considers implications for pediatric rehabilitation practice.

Design: A narrative review of PubMed-indexed studies published between 2010 and 2025 was conducted. Studies were included if they involved patients 21 years or younger with traumatic knee injuries managed surgically or nonoperatively and reported adherence to PM&R or physical therapy. To meet inclusion, studies also needed to examine at least one socioeconomic factor such as insurance type, race or ethnicity, family structure, housing stability, or travel distance. Exclusion criteria were adult-only populations, non-knee injuries, conditions not requiring structured rehabilitation, and studies without socioeconomic evaluation.

Results: Retrospective studies show that single-parent households, Hispanic/Latino ethnicity, and longer travel distance are linked to lower PT adherence, with only 9.1% of youth from single-parent homes and 0% of Hispanic/Latino patients meeting ≥85% attendance, compared to over 40% of peers. Public insurance and unstable housing were also associated with lower adherence, while privately insured adolescents attended more visits. Other studies confirm that Black, Hispanic, and Medicaid-insured patients faced longer delays to surgery, fewer PT sessions, and greater residual strength deficits nine months post-ACL reconstruction, despite similar complication rates. Collectively, these findings show that socioeconomic barriers reduce therapy exposure and worsen recovery.

Conclusions: There are clear socioeconomic disparities in adherence to pediatric PM&R after knee trauma. For physiatrists, this highlights the need for solutions that reduce barriers, such as transportation support, flexible scheduling, tele-rehabilitation, and culturally appropriate education. Addressing these issues can help ensure all adolescents have a fair chance at recovery.