Risk of Postoperative Stiffness Following Multiligamentous Knee Injury Surgery Is Not Affected by Obesity: A Multicenter Study

Bi, Andrew S; Mojica, Edward S.; Markus, Danielle H.; Blaeser, Anna M.; Kahan, Joseph B; Moran, Jay; Jazrawi, Laith M.; Medvecky, Michael J.; Alaia, Michael J.

doi:10.1016/j.arthro.2022.06.017

Cited by 7 publications

(19 citation statements)

References 26 publications

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“…Similarly, Bi et al found no difference in postoperative stiffness requiring manipulation under anesthesia (MUA)/lysis of adhesions following surgery when comparing obese and nonobese patients (p ¼ 0.31). 23,24 This contrasts with a study by Ridley et al that found MUA, along with failed grafts and revisions, to be less likely in obese patients. 14 BMI also does not appear to be significantly correlated with mid-to long-term mental health outcomes after surgery including symptoms of depression and painrelated anxiety.…”

Section: Discussionmentioning

confidence: 79%

Increased Body Mass Index is Associated with Worse Mid- To Long-Term Patient Outcomes after Surgical Repair of Multiligamentous Knee Injuries

Tan,

Ferrante,

DiBartola

et al. 2023

J Knee Surg

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Background: We evaluated the relationship between elevated body mass index (BMI) and mid- to long-term outcomes after surgical treatment of multi-ligamentous knee injury (MLKI). Methods: Records identified patients treated surgically for MLKI at a single institution. Inclusion criteria: minimum 2 years since surgery, complete demographics, surgical data, sustained injuries to 2 or more ligaments in one or both knees, and available for follow-up. Patients were contacted to complete patient-reported outcomes assessments and were classified according to mechanism of injury. Multivariate logistic regression analysis was used to predict the impact of BMI on outcome scores. Results: A total of 77 patients (72.7% male) were included with a mean age at the time of injury of 29.4 ± 11.0 years and a mean BMI of 30.5 ± 9.4 kg/m2. The mean length of follow-up was 7.4 years. For each 10 kg/m2 increase in BMI there is a 0.9 point decrease in Tegner activity scale (p=0.001), a 5 point decrease in KOOS-pain (p=0.007), a 5 point decrease in KOOS-ADL (p=0.003), a 10 point decrease in KOOS-QOL (p = 0.002), and an 11 point decrease in KOOS-Sport (p = 0.002). There were no significant correlations with BMI and PCS or PHQ-9 scores. Conclusions: Increasing BMI has a negative linear relationship with mid- to long-term clinical outcomes including pain, ability to perform activities of daily living, quality of life and ability to perform more demanding physical activity after MLKI. BMI does not appear to have a significant relationship with knee swelling and mechanical symptoms or patients’ mental health.

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Section: Discussionmentioning

confidence: 79%

Increased Body Mass Index is Associated with Worse Mid- To Long-Term Patient Outcomes after Surgical Repair of Multiligamentous Knee Injuries

Tan,

Ferrante,

DiBartola

et al. 2023

J Knee Surg

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“…As a result of the database searches, 1285 potentially eligible studies were identified, of which 89 duplicate studies were detected. After duplicate studies removed, 1,196 studies were scanned using titles and abstracts, 72 studies were included in the full‐text review to evaluate if they met the inclusion criteria, and 36 studies ultimately found to meet study eligibility criteria and were included in the systematic review and meta‐analysis [1, 2, 4–17, 19–23, 26, 29, 32–36, 41–44, 46, 47, 49, 50] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…The following data were extracted from studies: study characteristics (author, year of publication, sample size, study design, level of evidence), cohort demographics (age, sex, BMI), mean follow‐up length, Schenk classification [39], energy of injury mechanism (low and high energy), external fixator placement, timing of surgery (early or delayed surgery), concomitant knee pathologies (meniscus rupture, chondral injury, associated fractures), associated neurovascular injury, and number of patients who had stiffness after MLKI surgery. Postoperative stiffness was defined as limited range of motion (ROM) requiring arthroscopic arthrolysis surgery and/or manipulation under anesthesia (MUA) [5]. MLKI surgeries were defined as MLKIs operated on less than 3 weeks following injury in this meta‐analysis [13, 22].…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, the generalizability of previously identified risk factors remains unknown. For example, external fixator placement for maintaining pre‐operative joint reduction and staged surgery is reported risk factors for postoperative stiffness with reasonable agreement in the literature [5, 17]. However, there remains disagreement among studies on other potential risk factors, such as body mass index (BMI), injury severity and number of ligaments involved, associated neurovascular injury, and time to surgery [17, 32].…”

Section: Introductionmentioning

confidence: 99%

“…While there are studies reporting that obesity is not a risk factor for postoperative stiffness, it has been reported in a case series that high body mass index (BMI) is a risk factor for postoperative complication [5, 17, 32, 35]. Similar disagreement is also observed for neurovascular injury accompanying MLKI in two recent studies in the literature [5, 17]. In a cohort study involving 296 patients, it was reported that time to surgery was not associated with postoperative stiffness, whereas in two other studies involving fewer patients, acute and chronic surgeries are reported to be associated with postoperative stiffness [4, 14, 32].…”

Section: Introductionmentioning

confidence: 99%

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Early surgery and number of injured ligaments are associated with postoperative stiffness following multi‐ligament knee injury surgery: a systematic review and meta‐analysis

Özbek

Dadoo

Grandberg

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To perform a systematic review and meta‐analysis to investigate the rate of stiffness after multi‐ligament knee injury (MLKI) surgery and identify potential risk factors associated with postoperative stiffness. Methods This study was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) statement. Registration was done on the PROSPERO International Prospective Register of Systematic Reviews (CRD42022321849). A literature search of PubMed, Ovid, Embase, and Cochrane Library databases was conducted in October 2022 for clinical studies reporting postoperative stiffness after MLKI surgery. A quality assessment was performed using the Methodological Index of Non‐Randomized Studies (MINORS) grading system. The following variables were extracted from studies for correlation to postoperative stiffness: study characteristics, cohort demographics, Schenk classification, neurovascular injury, mechanism of injury, external fixator placement, timing of surgery, and concomitant knee injuries. Results Thirty‐six studies comprising 4,159 patients who underwent MLKI surgery met the inclusion criteria, including two Level‐II, fourteen Level‐III, and twenty Level‐IV studies. The average MINOR score of the studies was 14. The stiffness rate after MLKI was found to be 9.8% (95% CI 0.07–0.13; p < 0.01; I2 = 87%), and the risk of postoperative stiffness was significantly lower for patients with two ligaments injured compared to patients with ≥ 3 ligaments injured (OR = 0.45, 95% CI (0.26–0.79), p = 0.005; I2 = 0%). The results of the pooled analysis showed early surgery (< 3 weeks) resulted in significantly increased odds of postoperative stiffness compared with delayed surgery (≥ 3 weeks) (OR = 2.18; 95% CI 1.11–4.25; p = 0.02; I2 = 0%). However, age, gender, body mass index, energy of injury, and neurovascular injury were not associated with an increased risk of postoperative stiffness (n.s.). Conclusion Performing surgery within the first 3 weeks following MLKI, or concomitant injury of ≥ 3 ligaments, are significantly associated with increased risk of postoperative stiffness. These findings can be utilized by surgeons to decide the timing of surgery for MLKI surgeries especially in which ≥ 3 ligaments are injured. Level of evidence Level IV.

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Frailty is a predictor of immediate postoperative complications following surgical management of knee dislocations

Koltenyuk,

Merckling,

et al. 2024

Eur J Orthop Surg Traumatol

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Risk of Postoperative Stiffness Following Multiligamentous Knee Injury Surgery Is Not Affected by Obesity: A Multicenter Study

Cited by 7 publications

References 26 publications

Increased Body Mass Index is Associated with Worse Mid- To Long-Term Patient Outcomes after Surgical Repair of Multiligamentous Knee Injuries

Increased Body Mass Index is Associated with Worse Mid- To Long-Term Patient Outcomes after Surgical Repair of Multiligamentous Knee Injuries

Early surgery and number of injured ligaments are associated with postoperative stiffness following multi‐ligament knee injury surgery: a systematic review and meta‐analysis

Frailty is a predictor of immediate postoperative complications following surgical management of knee dislocations

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