2025 ISAKOS Biennial Congress ePoster
Impact of Obesity on Patient-Reported Outcomes Two Years after Multiple Ligament Knee Reconstruction
Laura De Ravin, BS, Baltimore, MD UNITED STATES
Michael Alan McCurdy, MD, Baltimore, Maryland UNITED STATES
Dominic J. Ventimiglia, MD, Baltimore, MD UNITED STATES
Alexandra B. Lutz, MD, Baltimore, MD UNITED STATES
Jonathan D. Packer, MD, Baltimore, MD UNITED STATES
Natalie Leong, MD UNITED STATES
Sean J. Meredith, MD, Baltimore, Maryland UNITED STATES
R Frank Henn, MD, Baltimore, MD UNITED STATES
University of Maryland School of Medicine, Baltimore, MD, UNITED STATES
FDA Status Not Applicable
Summary
Our study found that obesity was an independent predictor of worse pain and function two years after multiple ligament knee injury reconstruction.
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Abstract
Introduction
Body mass index (BMI) is a routine consideration in preoperative evaluation of potential surgical candidates, as obese patients pose increased surgical risk due to high rates of comorbid conditions such as cardiovascular disease, diabetes, and sleep apnea. In addition to heightened safety concerns, obesity has also been shown to impact outcomes after orthopaedic surgery. Multiple ligament knee injuries (MLKI) comprise 0.001 to 0.2% of all orthopedic injuries, making it difficult to conduct large-scale research on these small patient populations. Obese patients often sustain low-velocity MLKI, an injury occurring during activities of daily living rather than high-energy trauma. Although these injuries are lower energy than high-velocity MLKI, low-velocity MLKI are associated with poor outcomes and complication rates as high as 47%. To our knowledge, no study has investigated the association between obesity and PROs two years after MLKI reconstruction. Thus, the aim of our study was to investigate the relationship between obesity and PROs two years after MLKI reconstruction.
Methods
After Institutional Review Board (IRB) approval, a prospectively enrolled orthopaedic registry was queried for patients who had undergone MLKI reconstruction from January 2019 to March 2022. Included patients had reconstruction/repair of 2 or more ligaments. Patients were excluded if they underwent one cruciate reconstruction/repair and only medial collateral ligament (MCL) repair. Patient medical records were reviewed to record specific injury and surgical details. Patients were categorized as obese if they had a BMI ≥ 30 kg/m2. Eligible patients completed electronic surveys at baseline and two years postoperatively consisting of various PROs, including Patient-Reported Outcome Measurement Information System (PROMIS), International Knee Documentation Committee Subjective Knee Form (IKDC), Numeric Pain Scale (NPS), Marx Activity Rating Scale (MARS), and Tegner Activity Scale (TAS). Non-obese patients were compared to obese patients for statistical analysis. Bivariate analysis was used to identify associations between patient demographics, surgical characteristics, PROs and obesity. Multivariable regression analysis was utilized to identify obesity as an independent predictor of two-year outcomes.
Results
39 patients were eligible for this study, of which 28 (71.8%) completed 2-year PROs. 16 (57.1%) of patients had a BMI ≥ 30 and were placed in the obese group. Obese patients had higher American Society of Anesthesiologists (ASA) scores (p = .009). At two-year follow-up, obesity was associated with worse PROMIS Pain Interference (PI, p = .034), Fatigue (F, p = .022), NPS operative site (p = .002) and NPS body (p = .017). On regression analysis, non-obesity was a predictor of two-year PROMIS PI (p = .028), PROMIS F (p = .022), IKDC (p = .005), NPS operative site (p = .002) and NPS body (p = .047).
Conclusion
Our study found that obesity was an independent predictor of worse pain and function two years after MLKI reconstruction. These findings may inform surgeons about realistic expectations for recovery in these PROs. Future studies are necessary to corroborate these findings in prospective cohorts.