Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Cartilage. 2021 Dec;13(1_suppl):216S-227S. doi: 10.1177/1947603520923025. Epub 2020 May 20.
Arthroscopic partial meniscectomy (APM) is one of the most commonly performed surgical procedures. However, the indications for APM are controversial and obese patients may have worse outcomes. This study's primary purpose was to investigate differences in outcome after APM associated with elevated body mass index (BMI). Secondary objectives included differences in pathophysiology, surgical complications/failures, or osteoarthritis development.
MEDLINE, EMBASE, and OVID databases were systematically searched for eligible studies reporting on APM outcomes at a minimum of 1 year postoperatively. Studies that did not include BMI categorization were excluded. Meta-analysis was conducted with random-effects modeling where data from at least 2 studies was available.
A total of 16 articles were included. Overweight/obese BMI was associated with worse preoperative Lysholm (mean difference, -6.06 [95% CI, -11.70 to -0.42]) and visual analogue scale pain scores (0.43 [0.07 to 0.79]). Worse postoperative normalized knee-specific patient-reported outcome scores were also associated with obese BMI (-4.57 [-5.33 to -3.81]). There were no significant differences in clinical improvement or osteoarthritis progression among BMI groups. Two studies found higher complication/failure rates, 3 articles associated medial meniscus posterior root tears, and 1 article found differences in gene transcript expression with increased BMI.
Obesity is associated with worse knee function after APM, and patients with elevated BMI have worse preoperative knee pain and function. However, there is no difference in amount of improvement between elevated and normal BMI patients. Further prospective research is necessary to determine the comparative effectiveness of APM in patients with elevated BMI.
关节镜下半月板部分切除术（APM）是最常进行的手术之一。然而，APM 的适应证存在争议，肥胖患者的预后可能更差。本研究的主要目的是研究与体重指数（BMI）升高相关的 APM 术后结果的差异。次要目标包括病理生理学、手术并发症/失败或骨关节炎发展方面的差异。
系统检索了 MEDLINE、EMBASE 和 OVID 数据库中至少在术后 1 年报告 APM 结果的研究。排除了未包括 BMI 分类的研究。有至少 2 项研究提供数据的情况下，采用随机效应模型进行荟萃分析。
共纳入 16 篇文章。超重/肥胖 BMI 与术前 Lysholm 评分（平均差值，-6.06 [95%CI，-11.70 至-0.42]）和视觉模拟评分疼痛（0.43 [0.07 至 0.79]）更差相关。肥胖 BMI 也与术后标准化膝关节特定患者报告结局评分更差相关（-4.57 [-5.33 至-3.81]）。BMI 组之间的临床改善或骨关节炎进展无显著差异。两项研究发现更高的并发症/失败率，3 篇文章与内侧半月板后根撕裂相关，1 篇文章发现随着 BMI 增加基因转录表达存在差异。
肥胖与 APM 后膝关节功能更差相关，BMI 升高的患者术前膝关节疼痛和功能更差。然而，升高和正常 BMI 患者之间的改善程度没有差异。需要进一步前瞻性研究来确定 APM 在 BMI 升高患者中的比较效果。
