2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress ePoster

 

The Impact Of BMI And Concomitant Knee Pathology On Medial And Lateral Meniscus Tear Complexity In The Pediatric Population

Kristen N Riekersdorfer, BA, Boston, MA UNITED STATES
Serafina Faith Zotter, BS, Boston, Massachusetts UNITED STATES
Nikolaos K Paschos, MD, PhD, West Roxbury, Boston, MA UNITED STATES

Massachusetts General Hospital, Boston, MA, UNITED STATES

FDA Status Not Applicable

Summary

In pediatric patients, increased BMI is significantly associated with complex lateral meniscus tears, while complex medial meniscus tears are predominantly isolated injuries, emphasizing the need for thorough evaluation in children with elevated BMI and highlighting that BMI percentile adjustments may not adequately capture the risk for complex tear patterns.

ePosters will be available shortly before Congress

Abstract

Purpose

Complex meniscus tears are often degenerative and less amenable to repair, compared to meniscectomy. In the pediatric population, where preserving meniscus tissue is crucial for long-term knee health and osteoarthritis prevention, accurate identification and repair of these tears are vital. Previous research has identified obesity as a risk factor for meniscus tears, particularly complex and radial tears of the lateral meniscus. This study aims to evaluate how BMI, BMI percentile, and concomitant knee pathology influence the complexity of medial and lateral meniscus tears in the pediatric population.

Methods

This retrospective cohort study included all patients under 18 who underwent meniscus repair at our multi-center institution between 2017 and 2023, including both isolated and concomitant repairs. The primary outcome was the pattern of meniscal injury, classified intra-operatively as complex (≥2 tear patterns) or simple (single tear pattern). Demographic data collected included gender, age, weight, BMI, BMI percentile at the time of surgery, and injury mechanism. Logistic regression analyses were used to assess the impact of BMI, BMI percentile, concomitant knee pathology, and other demographic variables on the presence of complex meniscus tears. Separate regressions were performed due to multicollinearity between BMI and BMI percentile (VIF >10).

Results

The study included 401 patients with 487 meniscus tears. The cohort was 44.9% female, with a mean age of 15.8 ± 1.8 years, mean weight of 154.4 ± 41.8 lbs, and mean BMI of 24.2 ± 5.2 kg/m². Among the tears, 82 were classified as complex (17 medial, 65 lateral). Logistic regression analysis revealed that increased BMI was significantly associated with complex lateral meniscus tears (p < .05, 95% CI [0.001, 0.098]). In contrast, BMI percentile, sex, contact injury mechanism, and concomitant knee pathology were not significant predictors for complex versus simple tear patterns. For medial meniscus tears, the presence of isolated injury (without concomitant pathology) was significantly associated with increased complexity (p < .05, 95% CI [0.285, 2.375]), whereas BMI, BMI percentile, sex, and contact injury mechanism did not significantly contribute to complexity.

Conclusions

These data re-demonstrate the association between elevated BMI and complex lateral meniscus tears, underscoring the impact of absolute body mass on knee joint stress and meniscus integrity. The prevalence of complex medial tears occurring as isolated injuries highlights their potential for significant symptomatic burden, leading these patients to present a primary meniscal injury. Clinicians should therefore prioritize thorough evaluation and diagnostic arthroscopy for patients with elevated BMI, irrespective of BMI percentile or WHO weight classification.