The Effect of Body Mass Index on Clinical Outcomes in Patients Without Radiographic Evidence of Degenerative Joint Disease After Arthroscopic Partial Meniscectomy

Published:September 29, 2017DOI:https://doi.org/10.1016/j.arthro.2017.06.021

      Purpose

      To examine the effect of obesity on clinical outcomes at 1 year after arthroscopic partial meniscectomy.

      Methods

      We conducted a secondary analysis of the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial (N = 256). The visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and presence of effusion were assessed preoperatively and at 1 year after arthroscopic partial meniscectomy. Body mass index was categorized as normal weight, 24.99 or less; overweight, 25 to 29.99; or obese, 30 or greater. Analysis of variance or the Cochran-Mantel-Haenszel test was used to examine differences in clinical outcomes between body mass index categories, and mean ± standard deviation or number (percentage) is reported.

      Results

      Preoperatively, obese patients had worse WOMAC pain (56.2 ± 17.2 vs 61.3 ± 17.2, P = .02), WOMAC physical function (55.8 ± 17.1 vs 62.8 ± 17.1, P = .004), pain visual analog scale (4.9 ± 2.1 vs 4.2 ± 1.9, P = .01), KOOS pain (49.5 ± 14.9 vs 54.0 ± 15.1, P = .02), and KOOS quality-of-life (27.9 ± 18.3 vs 36.9 ± 17.0, P = .001) scores, as well as decreased flexion (121.8° ± 22.6° vs 132.3° ± 16.5°, P = .003), compared with normal-weight patients. Overweight patients (n = 51 [51.5%], P = .03) and obese patients (n = 56 [52.8%], P = .002) were more likely to have knee effusion before surgery than normal-weight patients (n = 17 [34%]). At 1 year after surgery, overweight (130.2° ± 7.7°, P = .03) and obese (128.1° ± 7.1°, P = .003) patients had decreased flexion compared with normal-weight patients (134.5° ± 8.3°).

      Conclusions

      Obese patients had worse pain, physical functioning, and quality-of-life scores, as well as decreased flexion, compared with normal-weight patients before arthroscopic partial meniscectomy. At 1 year after arthroscopic partial meniscectomy, there were no statistically significant differences in clinical outcomes but obesity was associated with decreased knee flexion.

      Level of Evidence

      Level II, prospective comparative trial.
      To read this article in full you will need to make a payment
      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Flegal K.M.
        • Kruszon-Moran D.
        • Carroll M.D.
        • Fryar C.D.
        • Ogden C.L.
        Trends in obesity among adults in the United States, 2005 to 2014.
        JAMA. 2016; 315: 2284-2291
        • Dervin G.F.
        • Stiell I.G.
        • Rody K.
        • Grabowski J.
        Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life.
        J Bone Joint Surg Am. 2003; 85: 10-19
        • Harrison M.M.
        • Morrell J.
        • Hopman W.M.
        Influence of obesity on outcome after knee arthroscopy.
        Arthroscopy. 2004; 20: 691-695
        • Spahn G.
        • Muckley T.
        • Kahl E.
        • Hofmann G.O.
        Factors affecting the outcome of arthroscopy in medial-compartment osteoarthritis of the knee.
        Arthroscopy. 2006; 22: 1233-1240
        • Ford G.M.
        • Hegmann K.T.
        • White Jr., G.L.
        • Holmes E.B.
        Associations of body mass index with meniscal tears.
        Am J Prev Med. 2005; 28: 364-368
        • Blazek K.
        • Favre J.
        • Asay J.
        • Erhart-Hledik J.
        • Andriacchi T.
        Age and obesity alter the relationship between femoral articular cartilage thickness and ambulatory loads in individuals without osteoarthritis.
        J Orthop Res. 2014; 32: 394-402
        • Rai M.F.
        • Patra D.
        • Sandell L.J.
        • Brophy R.H.
        Relationship of gene expression in the injured human meniscus to body mass index: A biologic connection between obesity and osteoarthritis.
        Arthritis Rheumatol. 2014; 66: 2152-2164
        • Himes C.L.
        • Reynolds S.L.
        Effect of obesity on falls, injury, and disability.
        J Am Geriatr Soc. 2012; 60: 124-129
        • Sofu H.
        • Oner A.
        • Camurcu Y.
        • Gursu S.
        • Ucpunar H.
        • Sahin V.
        Predictors of the clinical outcome after arthroscopic partial meniscectomy for acute trauma-related symptomatic medial meniscal tear in patients more than 60 years of age.
        Arthroscopy. 2016; 32: 1125-1132
        • Erdil M.
        • Bilsel K.
        • Sungur M.
        • et al.
        Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study.
        Arthroscopy. 2013; 29: 232-237
        • Haviv B.
        • Bronak S.
        • Thein R.
        Correlation between body mass index and chondral lesions in isolated medial meniscus tears.
        Indian J Orthop. 2015; 49: 176-180
        • Bisson L.J.
        • Kluczynski M.A.
        • Wind W.M.
        • et al.
        Design of a randomized controlled trial to compare debridement to observation of chondral lesions encountered during partial meniscectomy: The ChAMP (Chondral Lesions and Meniscus Procedures) trial.
        Contemp Clin Trials. 2015; 45: 281-286
        • Beaufils P.
        • Becker R.
        ESSKA meniscus consensus project.
        European Society of Sports Traumatology, Knee Surgery and Arthroscopy, Luxembourg2016
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43: 752-757
      1. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation.
        World Health Organ Tech Rep Ser. 2000; 894 (1-253): i-xii
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee Injury and Osteoarthritis Outcome Score (KOOS)—Development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Roos E.M.
        • Klassbo M.
        • Lohmander L.S.
        WOMAC osteoarthritis index. Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Western Ontario and MacMaster Universities.
        Scand J Rheumatol. 1999; 28: 210-215
        • Salata M.J.
        • Gibbs A.E.
        • Sekiya J.K.
        A systematic review of clinical outcomes in patients undergoing meniscectomy.
        Am J Sports Med. 2010; 38: 1907-1916
        • Kluczynski M.A.
        • Bisson L.J.
        • Marzo J.M.
        Does body mass index affect outcomes of ambulatory knee and shoulder surgery?.
        Arthroscopy. 2014; 30: 856-865
        • Harding G.T.
        • Hubley-Kozey C.L.
        • Dunbar M.J.
        • Stanish W.D.
        • Astephen Wilson J.L.
        Body mass index affects knee joint mechanics during gait differently with and without moderate knee osteoarthritis.
        Osteoarthritis Cartilage. 2012; 20: 1234-1242
        • Park W.
        • Ramachandran J.
        • Weisman P.
        • Jung E.S.
        Obesity effect on male active joint range of motion.
        Ergonomics. 2010; 53: 102-108
        • Escalante A.
        • Lichtenstein M.J.
        • Dhanda R.
        • Cornell J.E.
        • Hazuda H.P.
        Determinants of hip and knee flexion range: Results from the San Antonio Longitudinal Study of Aging.
        Arthritis Care Res. 1999; 12: 8-18
        • Laubach L.L.
        Body composition in relation to muscle strength and range of joint motion.
        J Sports Med Phys Fitness. 1969; 9: 89-97
        • Mathus-Vliegen E.M.
        Obesity and the elderly.
        J Clin Gastroenterol. 2012; 46: 533-544
        • Hmamouchi I.
        • Allali F.
        • Tahiri L.
        • et al.
        Clinically important improvement in the WOMAC and predictor factors for response to non-specific non-steroidal anti-inflammatory drugs in osteoarthritic patients: A prospective study.
        BMC Res Notes. 2012; 5: 58
        • Hubner C.
        • Schmidt R.
        • Selle J.
        • et al.
        Comparing self-report measures of internalized weight stigma: The Weight Self-Stigma Questionnaire versus the Weight Bias Internalization Scale.
        PLoS One. 2016; 11: e0165566
        • Puhl R.M.
        • Brownell K.D.
        Confronting and coping with weight stigma: An investigation of overweight and obese adults.
        Obesity (Silver Spring). 2006; 14: 1802-1815
        • Ciccotti M.C.
        • Kraeutler M.J.
        • Austin L.S.
        • et al.
        The prevalence of articular cartilage changes in the knee joint in patients undergoing arthroscopy for meniscal pathology.
        Arthroscopy. 2012; 28: 1437-1444
        • Bellamy N.
        • Buchanan W.W.
        • Goldsmith C.H.
        • Campbell J.
        • Stitt L.W.
        Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.
        J Rheumatol. 1988; 15: 1833-1840
        • Engelhart L.
        • Nelson L.
        • Lewis S.
        • et al.
        Validation of the Knee Injury and Osteoarthritis Outcome Score subscales for patients with articular cartilage lesions of the knee.
        Am J Sports Med. 2012; 40: 2264-2272