Abstract
Purpose
To investigate existing studies examining the association between body mass index
(BMI) and outcomes of anterior cruciate ligament reconstruction (ACLR) in adolescent
patients.
Methods
Literature search was conducted on Pubmed and Embase. Studies examining associations
between BMI and outcomes after ACLR in adolescents were included. Quality assessment
was performed. Data on patient age, gender, study design, time of follow-up, sample
size, graft type, concomitant injuries (meniscal injury, surgical procedures), clinical
outcomes (revision ACLR, post-operative weight gain, post-traumatic osteoarthritis
(PTOA), range of motion (ROM)) and functional outcome (muscle strength) were extracted.
Results
11 papers of evidence II-IV were included. Five studies found positive correlations
between BMI and risk of concomitant meniscal injuries. Two of them reported young
patients with elevated BMI having 1.6 times higher odds of requiring meniscectomy
(p<0.01) and 1.031 times higher odds of requiring concomitant surgeries (p=0.011).
One study showed significant positive association of post-operative weight gain by
time (r=0.28, p<0.01), with smaller increase in the overweight and obese groups compared
to the normal weight group. One study demonstrated greater cartilage breakdown in
young overweight and obese patients post-surgery, contributing to PTOA (r=0.42, p=0.009).
There was no clinically important difference in postoperative ROM and muscle strength.
Four studies reviewed the association between BMI and revision ACLR risk, but results
were heterogeneous and a firm conclusion cannot be drawn.
Conclusions
Adolescents with elevated BMI are more likely to have concomitant meniscal injuries
and surgical procedures after ACL tear. There is some weak evidence of the association
of elevated BMI with PTOA and slight post-operative weight gain post-ACLR. There may
not be any clinically significant association of obesity with post-operative muscle
strength and ROM, and current studies are inconclusive regarding the impact of BMI
on revision ACLR risk.
Keywords
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Article Info
Publication History
Accepted:
May 12,
2022
Received in revised form:
May 3,
2022
Received:
February 12,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of Interest
The authors have no conflicts of interest related to this article.
Funding- This study was supported by the Innovation and Technology Commission – Hong Kong for Center for Neuromusculoskeletal Restorative Medicine (ITC RC/IHK/4/7).
Authors’ contributions
Ashley Cheuk Hei ANG, Doris WONG and Pauline Po Yee LUI conceived the idea and design the study. Ashley Cheuk Hei ANG and Doris WONG performed the literature search. Pauline Po Yee LUI supervised the study and provided opinion if consensus could not be reached. All investigators participated in data interpretation. Ashely Cheuk Hei ANG and Doris WONG drafted the manuscript and Pauline Po Yee LUI finalized the manuscript. All authors read and approved the final work.
Acknowledgement
None
Level of Evidence: Level IV, systematic review of Level II-IV studies
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
