Does Obesity Negatively Affect the Functional Results of Arthroscopic Partial Meniscectomy? A Retrospective Cohort Study

doi:10.1016/j.arthro.2012.08.017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 29, Issue 2, February 2013, Pages 232-237

https://doi.org/10.1016/j.arthro.2012.08.017 Get rights and content

Purpose

The purpose of this study was to evaluate the impact of body mass index (BMI) on early functional results of patients who undergo isolated partial meniscectomy.

Methods

The functional results for 1,090 patients who underwent partial meniscectomy, in 2 different orthopaedic clinics, were evaluated retrospectively. The study includes cases with arthroscopic partial meniscectomy for isolated meniscal tears; patients with concomitant knee pathology were excluded. Three hundred forty-one (31%) patients with isolated lateral meniscal tears, 628 (58%) patients with isolated medial meniscal tears, and 121 (11%) patients with both medial and lateral meniscal tears underwent arthroscopic partial meniscectomy. We divided these patients into 3 subgroups on the basis of their BMI; <26, between 26 and 30, ≥30. Preoperative functional results were compared with 1-year postoperative follow-up results using the International Knee Documentation Committee (IKDC),²⁶ Lysholm Knee Scale,²⁷ and Oxford Scoring System²⁸ scores.

Results

According to all 3 knee scales, age, side of lesion, and tear type had no effect on functional outcome. When compared with the group with BMI <26, the patients with BMI between 26 and 30 and the patients with BMI ≥30 had significantly worse outcomes as measured by the IKDC, Oxford Scoring System, and Lysholm Knee Scale scores. Patients with BMI between 26 and 30 and ≥30 did not have significantly different functional outcomes.

Conclusions

Short-term outcomes after arthroscopic partial menisectomy reflect significant improvement in subjective outcome. However, patients with moderate or significant obesity (BMI >26) have inferior short-term outcomes compared with nonobese patients.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

In this study, 4,543 patients, who had undergone arthroscopic partial meniscectomy at 2 orthopaedic centers between 1997 and 2010 were evaluated retrospectively. The patients underwent surgery by 4 different surgeons (M.E., 61 patients; K.B., 52 patients; I.T., 304 patients, and M.A., 673 patients). Follow-up data were obtained by 3 surgeons (M.E., I.T., M.A.). Surgical reports from the computerized database and charts were reviewed for exclusion and inclusion criteria for the study by 4

Results

One thousand ninety knees in 1,090 patients were included in the study. At the end of the first year of follow-up, there was a significant improvement in the IKDC score, which increased from a mean of 48.80 to 90.72 (P < .001); the Lysholm Knee Scale score, which increased from 53.02 to 89.04 (P < .001); and the Oxford Scoring System score, which increased from 28.91 to 42.98 (P < .001). Men and women had similar rates of improvement in the IKDC (P = .676) and Lysholm (P = .875) scores.

Discussion

We evaluated 1,090 patients who had undergone partial meniscectomy for isolated meniscal tears. At 1 year of follow-up, mean IKDC, Oxford, and Lysholm functional scores had improved (P < .001). Mean functional scores for all 3 scales also improved for each BMI subgroup. However, the mean improvements for the overweight and obese groups were significantly lower than that for the normal weight group, thus supporting our hypothesis. The rate of recovery of function decreased with increasing BMI.

Conclusions

Short-term outcomes after arthroscopic partial meniscectomy show significant improvement in subjective outcome. However, patients with moderate or significant obesity (BMI >26) have inferior short-term outcomes compared with nonobese patients.

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Editorial Commentary: Obesity Is Associated With Lower Hip Function Pre- and Postoperatively and Increased Time to Patient Acceptable Symptom State After Hip Arthroscopy
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
In 2015, worldwide, there were more than 1.9 billion adults classified as having overweight (body mass index [BMI] >25), with 600 million of these individuals meeting the definition of obesity (BMI >30). Hip arthroscopy in patients with obesity can lead to improve outcomes, albeit with lower absolute levels of patient-reported outcome scores and with increased risk of complications and conversion rates to total hip arthroplasty when compared with their counterparts without obesity. Importantly, a significantly longer time to patient acceptable symptoms state achievement is seen for patients with class I obese than patients with normal BMI. Unfortunately, the hip is quite susceptible to the effects of obesity, with greater acetabular depth/deformity, reduced femoral head cartilage, greater forces experienced with ambulation, and a predisposition to femoroacetabular impingement syndrome. Thus, almost 42% of patients operated on in North America for femoroacetabular impingement syndrome are classified as having overweight or obesity. This does not need to deter from the consideration of arthroscopic hip surgery in the population with obesity; rather, it supports a discussion between surgeon and patient on expectations and timeline for improvement.
Return to sport after arthroscopic surgery for femoroacetabular impingement
2023, Surgeon
Femoroacetabular impingement (FAI) is common among the active and young population. The present study analysed the rate of return to sport, related influencing factors, and the sport activity level according to the Hip Outcome Score - Sport-Specific Subscale (HOS-SSS).
The literature search was performed in December 2020. All clinical trials investigating HOS-SSS and/or return to sport after arthroscopic treatment for FAI were considered for inclusion. The outcomes of interest were to analyse the rate of return to sport and the sport activity level according to the HOS-SSS in patients who underwent arthroscopic osteoplasty for FAI.
Data from 41 studies (4063 procedures) were retrieved. A total of 88.75% (581 of 655) of patients returned to sports within a mean of 37.4 ± 16.5 months. The HOS-SSS score improved from 45.0 ± 10.6 to 73.1 ± 9.5 (P < 0.0001) at last follow-up. The following baseline characteristics evidenced positive association with post-operative activity level: lighter weight (P = 0.01), younger age (P = 0.001), Tönnis angle grade I (P = 0.009), greater HHS (P = 0.01), NAHS (P < 0.0001) and HOS-ADL (P = 0.01).
Arthroscopic treatment for FAI resulted in excellent results in terms of return to sport. Moreover, lighter weight and younger age, greater HHS, NAHS, HOS-ADL at baseline were positively associated with post-operative sport activity level.
IV, systematic review.
The Effect of Body Mass Index on Clinical Outcomes in Patients Without Radiographic Evidence of Degenerative Joint Disease After Arthroscopic Partial Meniscectomy
2017, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
The ChAMP trial offers a distinct opportunity to examine the association between BMI and outcomes in patients without radiographic evidence of substantial degenerative joint disease because this population was excluded from the trial. A few studies have shown worse outcomes in patients with increased BMI after meniscus surgery; however, none of these studies examined the association between BMI and outcomes in patients undergoing arthroscopic partial meniscectomy without substantial radiographic evidence of degenerative joint disease.3,4,9,10 A systematic review by Salata et al.18 reported that BMI is one of many preoperative factors that predict poor clinical outcomes after arthroscopic meniscectomy.
To examine the effect of obesity on clinical outcomes at 1 year after arthroscopic partial meniscectomy.
We conducted a secondary analysis of the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial (N = 256). The visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and presence of effusion were assessed preoperatively and at 1 year after arthroscopic partial meniscectomy. Body mass index was categorized as normal weight, 24.99 or less; overweight, 25 to 29.99; or obese, 30 or greater. Analysis of variance or the Cochran-Mantel-Haenszel test was used to examine differences in clinical outcomes between body mass index categories, and mean ± standard deviation or number (percentage) is reported.
Preoperatively, obese patients had worse WOMAC pain (56.2 ± 17.2 vs 61.3 ± 17.2, P = .02), WOMAC physical function (55.8 ± 17.1 vs 62.8 ± 17.1, P = .004), pain visual analog scale (4.9 ± 2.1 vs 4.2 ± 1.9, P = .01), KOOS pain (49.5 ± 14.9 vs 54.0 ± 15.1, P = .02), and KOOS quality-of-life (27.9 ± 18.3 vs 36.9 ± 17.0, P = .001) scores, as well as decreased flexion (121.8° ± 22.6° vs 132.3° ± 16.5°, P = .003), compared with normal-weight patients. Overweight patients (n = 51 [51.5%], P = .03) and obese patients (n = 56 [52.8%], P = .002) were more likely to have knee effusion before surgery than normal-weight patients (n = 17 [34%]). At 1 year after surgery, overweight (130.2° ± 7.7°, P = .03) and obese (128.1° ± 7.1°, P = .003) patients had decreased flexion compared with normal-weight patients (134.5° ± 8.3°).
Obese patients had worse pain, physical functioning, and quality-of-life scores, as well as decreased flexion, compared with normal-weight patients before arthroscopic partial meniscectomy. At 1 year after arthroscopic partial meniscectomy, there were no statistically significant differences in clinical outcomes but obesity was associated with decreased knee flexion.
Level II, prospective comparative trial.
Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau
2017, Arthroscopy - Journal of Arthroscopic and Related Surgery
To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears.
A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded.
A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47).
Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear.
Level III, case-control study.
The Effects of Patient Obesity on Early Postoperative Complications After Shoulder Arthroscopy
2016, Arthroscopy - Journal of Arthroscopic and Related Surgery
To report the prevalence of obesity in shoulder arthroscopy, determine a body mass index (BMI) threshold most predictive of complication within 30 days, and evaluate obesity as an independent risk factor for medical and surgical complications.
Using the National Surgical Quality Improvement Program database, we reviewed all patients who underwent shoulder arthroscopy during 2011 to 2013. Receiver operating characteristic and Youden coefficient were calculated to find an optimal BMI cutoff to predict complications within 30 days of surgery. A case-control matched analysis was then performed by stratifying patient BMI by this cutoff and matching patients one to one according to age, sex, type of shoulder arthroscopy, American Society of Anesthesiology rating, surgical setting, and 8 comorbidities. Operating time, complications, and readmissions were also compared.
Of the 15,589 patients who underwent shoulder arthroscopy, 6,684 (43%) were classified as obese when using the optimal cutoff point of BMI = 30 according to the Youden coefficient. Obese patients had a higher risk of superficial site infection than nonobese patients (0.3% vs 0.0%; odds ratio [OR]: 6.00; 95% confidence interval [CI], 1.3 to 26.8; P = .015). Obese patients did not have significantly increased risk for overall early postoperative complication (1.2% compared with nonobese 0.8%; OR: 1.54; 95% CI, 1.0 to 2.4), readmissions (OR: 0.85; 95% CI, 0.5 to 1.5), or increased operating time (P = .068).
Up to 43% of patients undergoing shoulder arthroscopy can be classified as obese, but early perioperative complications are uncommon. Higher patient BMI is associated with increased risk of superficial site infection but not an overall risk for complication, readmission, or increased operating time.
Level III, retrospective comparative study.
Is Obesity a Risk Factor for Adverse Events After Knee Arthroscopy?
2016, Arthroscopy - Journal of Arthroscopic and Related Surgery
To evaluate how body mass index (BMI) affects rates of 30-day complication, hospital readmissions, and mortality in patients undergoing knee arthroscopy.
Patients undergoing knee arthroscopy procedures between 2006 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics and preoperative risk factors including BMI were analyzed for postoperative complications within 30 days. Cochran-Armitage testing was performed to detect differences in complication rates across BMI categories according to World Health Organization classification. The independent risk of BMI was assessed using multivariate regression analysis.
Of 41,919 patients with mean age 48 years undergoing knee arthroscopy, 20% were classified as normal weight (BMI 18.5 to 24), 35% overweight (BMI 25 to 29), 24% obese class I (BMI 30 to 34), 12% class II (BMI 35 to 40), and 9% class III (BMI ≥40). Risk of complication increased significantly with increasing BMI (normal: 1.5%, overweight: 1.6%, obese class I: 1.7%, obese class II: 1.8%, obese class III: 1.9%, P = .043). On multivariate analysis, there was no increased risk of postoperative complication directly attributed to patient BMI. Independent risk factors for medical and surgical complications after knee arthroscopy included American Society of Anesthesiologists (ASA) rating (class 4 v class 1 odds ratio [OR]: 5.39 [95% confidence interval: 3.11-9.33], P < .001), functional status for activities of daily living (dependent v independent OR: 2.13 [1.42, 3.31], P < .001), history of renal comorbidity (presence v absence OR: 5.10 [2.30, 11.29], P < .001), and previously experienced history of wound infection prior to current surgery (presence v absence OR: 4.91 [2.88, 8.39], P < .001).
More than 40% of knee arthroscopy patients qualify as obese. Although univariate analysis suggests that obesity is associated with increased postoperative complications within 30 days of surgery, BMI alone does not predict complications. Independent predictors of complications include patients with high ASA classification, dependent functional status, renal comorbidities, and a recent history of wound infection.
Level IV, prognostic case series.

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: The authors report that they have no conflicts of interest in the authorship and publication of this article.

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Original ArticleDoes Obesity Negatively Affect the Functional Results of Arthroscopic Partial Meniscectomy? A Retrospective Cohort Study

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Am J Clin Nutr

J Pediatr Surg

J Shoulder Elbow Surg

J Am Coll Surg

Arthroscopy

Arthroscopy

Arthroscopy

PM&R

Ambulatory arthroscopic knee surgery results of partial meniscectomy

J Pakistan Med Assoc

Meniscal injury: I. Basic science and evaluation

J Am Acad Orthop Surg

The menisci: Basic science and advances in treatment

Br J Sports Med

Meniscal tears: The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee: A preliminary report

Am J Sports Med

The contact area and pressure distribution pattern of the knee: A study of normal and osteoarthritic knee joints

Acta Orthop Scand

Fundamentals of articular cartilage and meniscus biomechanics

Arthroscopic meniscectomy

Instr Course Lect

Original Article
Does Obesity Negatively Affect the Functional Results of Arthroscopic Partial Meniscectomy? A Retrospective Cohort Study