BACKGROUND: This study aimed to evaluate the influence of socioeconomic status (SES), assessed by child opportunity index (COI) and insurance type, on access to orthopaedic care after pediatric ACL rupture. The secondary aim was to determine whether delays to care were associated with additional procedures at the time of ACL reconstruction (ACLR). METHODS: This IRB-approved retrospective study reviewed 238 patients aged 10 to 21 who underwent primary ACLR between 2013 and 2021 at a tertiary care center. Demographic and clinical data were obtained via chart review. The time intervals analyzed included the date of injury to the initial orthopaedic visit, the date of the initial visit to the MRI examination, and the date of the MRI examination to surgery. Patients were grouped by time intervals of ≤30 days versus >
30 days. COI scores (total and 3 domains: education, SES, and health) were determined by ZIP code and assigned quintile-ranking scores (very low/low and moderate/high/very high). χ2 and Fisher exact tests were used to compare patients with prompt versus delayed orthopaedic care. RESULTS: A total of 238 patients (mean age 16.51±1.73, 66.0% male, 63.1% public insurance, and 87.4% with very low or low total COI scores) were included in this study. There were no significant differences in insurance type or demographics between those with prompt or delayed care. No significant differences were found in total COI, education COI, socioeconomic COI, or health COI between patients with care within or after 30 days. Patients with delayed initial orthopaedic visits had a significantly higher prevalence of meniscus tears requiring repair (56.7% vs. 38.9%, P=0.004) or meniscectomy (24.7% vs. 22.9%, P=0.004). CONCLUSIONS: Lower SES, as measured by COI and public insurance, did not impact time to orthopaedic care after pediatric ACL injury. Within a predominantly minority population with low COI, the effect of COI on access to care may be less pronounced than in white-majority settings. Community-based interventions may help recognize telltale signs of ACL injury, ensuring an orthopaedic visit within a month of injury and decreasing the incidence of meniscus tears. LEVEL OF EVIDENCE: Level III-retrospective cohort study.