Purpose
The purpose of this study was to examine the relationship between obesity and postoperative
stiffness following surgical management of multiligamentous knee injuries (MLKIs)
using a large two-center cohort, by both 1) using binary cutoffs at various body mass
indexes (BMIs) and 2) a linear regression model.
Methods
190 consecutive patients who underwent surgical management of MLKIs between January
2001 and March 2020 were reviewed at two level 1 academic trauma centers. Patient
demographics, surgical characteristics, and manipulation under anesthesia (MUA)/lysis
of adhesions (LOA) were reviewed. Patients were stratified by obesity grades: grade
1 (BMI 30 to <35) grade 2 (BMI 35 to <40); grade 3 (BMI >40), and compared with a
nonobese comparison group with BMI <30. Multivariate logistic regressions were performed,
including the covariates of age, gender, BMI, acute versus chronic injury, external
fixator, vascular injury, knee dislocation, and Schenck Classification. Fisher’s exact
test was used to compare rate of MUA between grades of obesity. Analyses were performed
with R. Statistical significance was set at P < .05.
Results
The mean BMI of the cohort was 29.2 kg/m2. The mean overall follow-up was 27.2 ± 7.2 months (range: 14–142 months). There were
55 (29.1%) MUA procedures observed at a mean 3.77 ± 2.18 months (range: 1.8–9.7 months)
after final MLKI surgery. No significant difference was found in BMI of patients who
underwent a MUA compared to patients who did not (30.2 vs 28.8; P = .67). There was no significant difference in rate or time to MUA following MLKI
surgery between groups, with logistic regression demonstrating no significance (P = .144). Use of external fixation at the index surgery (OR = 3.3 [95% CI: 2.2, 4.7;
P < .0001]) and vascular injury (OR = 6.2 [95% CI: 1.8, 24.5; P = .005]) were found to be independent predictors for need for MUA.
Conclusion
No difference in risk for postoperative stiffness requiring MUA following surgery
for MLKI was found based on BMI. At all BMI levels, there were no significant increase
in need for postoperative MUA, suggesting at minimum a neutralizing effect of obesity
on postoperative stiffness. In addition, patients with external fixator use and vascular
injury at index surgery were found to be at significantly higher risk for postoperative
stiffness requiring MUA following surgery for MLKI. Surgeons should be aware of the
risk factors for arthrofibrosis when proceeding with surgical repair or reconstruction
of two or more ligaments of the knee.
Level of Evidence
III, multicenter retrospective cohort study.
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 6,
2022
Received:
November 3,
2021
Footnotes
See commentary on page 3182
The authors report the following potential conflicts of interest or sources of funding: M.J.A. reports research support from Arthrex and Concours Pharmaceuticals; and consulting fees from Mitek, outside the submitted work. L.M.J. reports research support from Arthrex, Mitek, and Smith & Nephew, outside the submitted work. M.J.M. reports speaker fees from Smith & Nephew, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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