Lian Jayson, Patel Neel K, Nickoli Michael, Vaswani Ravi, Irrgang James J, Lesniak Bryson P, Musahl Volker
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Knee Surg. 2020 Jun;33(6):525-530. doi: 10.1055/s-0039-1681027. Epub 2019 Mar 1.
The objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m, on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (I&D) and revision ligament surgery. A retrospective review was performed on 143 individuals who underwent surgery for an MLKI between 2011 and 2018 at a single academic center. Patients were included if there was a plan for potential surgical repair/reconstruction of two or more ligaments. Patients with prior surgery to the affected knee or intra-articular fracture requiring reduction and fixation were excluded. Comparisons between obese and nonobese patients were made using two-sample -test and either chi-square or Fisher's exact test for continuous and categorical variables, respectively. Significance was set at < 0.05. Of 108 patients meeting inclusion criteria, 83 had BMI < 35 kg/m and 25 had BMI ≥ 35 kg/m. Obese patients sustained higher rates of MLKI due to ultralow velocity mechanisms (28.0 vs. 1.2%; = 0.0001) and higher rates of concomitant lateral meniscus injury (48.0 vs. 25.3%; = 0.04). Among patients undergoing single-staged surgery, obese patients had significantly longer duration of surgery (219.8 vs. 178.6 minutes; = 0.02) and more wound infections requiring I&D (20.0 vs. 4.8%; = 0.03). In contrast, nonobese patients had higher rates of arthrofibrosis requiring manipulation under anesthesia and/or arthrolysis (25.3 vs. 0%; = 0.003). Obese patients undergoing surgery of an MLKI have longer operative times, greater rates of wound infection requiring I&D, and lower rates of arthrofibrosis. Surgeons may consider these results when counseling patients on their postoperative course and risk for complications. Future research might focus on strategies to reduce complication rates in obese patients with MLKI. This is a Level III, retrospective comparative study.
目的是报告肥胖（采用体重指数（BMI）阈值35kg/m²）对多韧带膝关节损伤（MLKI）的手术结果和并发症的影响。研究假设肥胖患者的手术时间和住院时间更长，估计失血量更大，伤口感染需要冲洗和清创（I&D）以及韧带翻修手术的发生率更高。对2011年至2018年在一个学术中心接受MLKI手术的143例患者进行了回顾性研究。如果计划对两条或更多韧带进行潜在的手术修复/重建，则纳入患者。排除先前患侧膝关节手术或需要复位和固定的关节内骨折患者。分别使用双样本t检验和卡方检验或Fisher精确检验对肥胖和非肥胖患者的连续变量和分类变量进行比较。显著性设定为P＜0.05。在108例符合纳入标准的患者中，83例BMI＜35kg/m²，25例BMI≥35kg/m²。肥胖患者因极低速度机制导致的MLKI发生率更高（28.0%对1.2%；P = 0.0001），外侧半月板损伤的发生率也更高（48.0%对25.3%；P = 0.04）。在接受一期手术的患者中，肥胖患者的手术时间明显更长（219.8分钟对178.6分钟；P = 0.02），需要I&D的伤口感染更多（20.
