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
A 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, sex, study design, time of follow-up, sample size,
graft type, concomitant injuries (meniscal injury, surgical procedures), clinical
outcomes (revision ACLR, postoperative weight gain, post-traumatic osteoarthritis
[PTOA], range of motion [ROM]), and functional outcome (muscle strength) were extracted.
Results
Eleven papers of Levels II-IV evidence 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 greater odds of requiring meniscectomy
(P < .01) and 1.031 times greater odds of requiring concomitant surgeries (P = .011). One study showed significant positive association of postoperative weight
gain by time (r = 0.28, P < .01), with smaller increase in the overweight and obese groups compared with the
normal-weight group. One study demonstrated greater cartilage breakdown in young patients
with overweight and obesity postsurgery, contributing to PTOA (r = 0.42, P = .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 postoperative 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.
Level of Evidence
Level IV, systematic review of Level II-IV studies.
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Article info
Publication history
Published online: June 01, 2022
Accepted:
May 12,
2022
Received:
February 12,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: Center for Neuromusculoskeletal Restorative Medicine (ITC RC/IHK/4/7) funded by the Innovation and Technology Commission (Hong Kong). ICMJE author disclosure forms are available for this article online, as supplementary material.
Ashley Cheuk Hei Ang and Doris Wong contributed equally to this article.
Identification
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© 2022 by the Arthroscopy Association of North America
