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BMI did not affect clinical outcomes after arthroscopic partial meniscectomy
Despite the presence of worse pain, physical function and quality of life scores and decreased flexion among obese patients prior to arthroscopic partial meniscectomy, results showed no statistically significant differences in clinical outcomes between normal-weight and obese patients at 1-year follow-up.
In a secondary analysis of the Chondral Lesions and Meniscal Procedures Randomized Trial, Leslie J. Bisson, MD, and colleagues assessed VAS for pain, WOMAC, KOOS, range of motion and presence of effusion preoperatively and at 1-year postoperatively among 258 patients who underwent arthroscopic partial meniscectomy. Researchers categorized patients according to BMI as normal weight (n=50), overweight (n=100) or obese (n=106).
Results showed worse WOMAC pain, WOMAC physical function, pain VAS, KOOS pain and KOOS quality-of-life scores, as well as decreased flexion among patients who were obese prior to arthroscopic partial meniscectomy. Prior to surgery, researchers noted a higher chance of patients who were overweight and obese undergoing knee effusion vs. patients who were normal-weight. Flexion decreased in patients who were overweight and obese at 1 year after surgery, according to results, while no statistically significant difference of the clinical and functional measures for normal-weight, overweight and obese patients was found between preoperative and 1-year scores.
“Past studies have found increased BMI to be associated with worse outcomes following arthroscopic meniscal surgery, but these studies may have been confounded by the facts that higher BMI is associated with chondral lesions and that chondral lesions are associated with poorer outcomes after arthroscopy,” Bisson told Healio.com/Orthopedics. “Secondary analysis of data from the Chondral Lesions and Meniscal Procedures (CHAMP) Randomized Trial, which excluded subjects with radiographic evidence of knee [degenerative joint disease] DJD, found that overweight and obese patients had similar outcomes to those with normal BMI after arthroscopic meniscectomy.” – by Casey Tingle
Disclosures: Bisson reports funding from the Ralph C. Wilson Jr. Foundation. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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This study is helpful as we counsel our patients, many of which are obese, about what to expect following arthroscopic partial meniscectomy. It has long been held that overweight and obese patients are more prone to poorer outcomes following arthroscopic intervention for meniscus tears. However, this double-blind, randomized controlled trial by Bisson and colleagues shows that patients with healthy cartilage may do well in the short-term regardless of their BMI. As such, the presence of significant chondral pathology, not symptomatic meniscus tears, appears to be the most important factor for whether obese patients get significantly better following arthroscopic partial meniscectomy.
There are several limitations in this work, however. One of the biggest is outcomes are only reported at 1 year following surgery. It is certainly conceivable that over the long-term, obese patients may have faster chondral degeneration following partial meniscectomy than normal-weight individuals due to inherently increased chondral load following a procedure that is known to increase joint contact pressures in the knee. Nonetheless, the authors should be commended on identifying a useful research question within the premise of the CHAMP Trial.
Perspective
Back to TopObesity is a well-established risk factor for complications and inferior outcomes in a variety of orthopedic surgeries ranging from arthroplasty to knee arthroscopy and partial meniscectomy. However, patients with increased BMI exhibit painful, functionally limiting orthopedic pathology that frequently requires surgical management. This study demonstrates efficacy of arthroscopic partial medial meniscectomy in obese patients without degenerative changes as no differences in clinical outcomes were found. While knee flexion was noted to be decreased in obese patients postoperatively, this was a consistent preoperative finding and therefore unlikely related to surgery. Overall, properly indicated patients without degenerative radiographic findings who failed conservative management improve with arthroscopic partial meniscectomy, regardless of BMI.
Optimistically, fixing orthopedic pathology in obese patients can act as a catalyst for weight reduction and overall improvement in patient health. Obese patients frequently enter a declining cycle of immobility that typically follows a timeline of a sedentary lifestyle, development of functionally limiting joint pain, further immobility and an inability to lose weight. Realistically, most obese patients will not use restored function and decreased joint pain to make complete lifestyle changes. Despite that, these findings are encouraging and provide evidence surgeons may use to educate similar obese patients. The obvious concern is long-term joint health. Whether obese patients experience more rapid degenerative decline, and if weight reduction can actually slow the degenerative process, is unknown.