Byun Junwoo, Yoon Han-Kook, Oh Hyun-Cheol, Youk Taemi, Ha Joong-Won, Kang Seungyeon, Park Sang-Hoon
Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
Orthop J Sports Med. 2024 Aug 21;12(8):23259671241266597. doi: 10.1177/23259671241266597. eCollection 2024 Aug.
The long-term goal of anterior cruciate ligament (ACL) reconstruction is to prevent secondary osteoarthritis due to instability. Obesity itself is also a risk factor for osteoarthritis and shows an increase in its incidence, but little is known about the relationship between obesity and the outcome of ACL reconstruction.
PURPOSE/HYPOTHESIS: This study aimed to determine the relationship between the outcome of ACL reconstruction and obesity. It was hypothesized that obesity would be associated with the revision rate of ACL reconstruction and additional surgical treatment for osteoarthritis in patients who undergo ACL reconstruction.
Cohort study; Level of evidence, 3.
Claims and health screening data of the National Health Insurance Service were used to analyze patients who underwent ACL reconstruction between January 1, 2003, and December 31, 2021. The association between obesity and risk of revision ACL reconstruction and additional surgical treatment for osteoarthritis or meniscal lesion was analyzed. Body mass index (BMI) was used to classify patients as underweight (BMI, <18.5), normal weight (BMI, 18.5-24.9), overweight (BMI, 25.0-29.9), obese (BMI, 30.0-39.9), or morbidly obese (BMI, ≥40.0). Multivariable Cox proportional hazards model analysis was conducted.
A total of 56,734 patients were included. Of them, 311 (0.5%) patients were underweight, 26,613 (46.9%) were normal weight, 24,372 (43.0%) were overweight, 5324 (9.4%) were obese, and 114 (0.2%) patients were morbidly obese. The underweight group showed a significantly lower risk of revision ACL reconstruction than the normal weight group (hazard ratio [HR], 0.54; 95% CI, 0.31-0.93; = .0273). However, the overweight, obese, and morbidly obese groups had no significant difference from the normal weight group. The risk of high tibial osteotomy (HTO) or total knee arthroplasty (TKA) was significantly high for the overweight (HR, 1.93; 95% CI, 1.70-2.19; < .0001) and obese (HR, 2.71; 95% CI, 2.23-3.30; < .0001) groups. Subgroup analysis performed in patients ≥40 years of age for the risk of HTO showed a significant increased risk in the overweight group (HR, 1.889; 95% CI, 1.56-2.29; < .0001) and obese group (HR, 2.78; 95% CI, 2.10-3.69; < .0001). Subgroup analysis performed in patients ≥50 years of age for the risk of TKA also showed a significant increased risk in the overweight group (HR, 2.03; 95% CI, 1.67-2.47; < .0001) and obese group (HR, 2.53; 95% CI, 1.83-3.50; < .0001). After adjusting for meniscal injury at index surgery by multivariate regression analysis, 1.87- and 2.75-fold increased risks of HTO were identified for the overweight and obese groups, respectively, for patients aged >40 years. For patients aged >50 years, 2.02-fold and 2.52-fold increased risks of TKA were observed for the overweight and obese groups, respectively. The risk of additional surgery due to the meniscal lesion was high for the overweight (HR, 1.09; 95% CI, 1.03-1.15; = .002) and obese (HR, 1.10; 95% CI, 1.01-1.21; = .0351) groups, while no significant difference was found for the underweight and morbidly obese groups.
This study highlights that obesity does not increase the revision rate of ACL reconstruction. However, the risk of additional surgical treatment for osteoarthritis and meniscal lesions increased as BMI increased. Further investigation is needed to determine the efficacy of ACL reconstruction for preventing osteoarthritis in obese patients.
前交叉韧带（ACL）重建的长期目标是预防因不稳定导致的继发性骨关节炎。肥胖本身也是骨关节炎的一个危险因素，且其发病率呈上升趋势，但关于肥胖与ACL重建结果之间的关系知之甚少。
目的/假设：本研究旨在确定ACL重建结果与肥胖之间的关系。研究假设肥胖与接受ACL重建患者的ACL重建翻修率以及骨关节炎的额外手术治疗有关。
队列研究；证据等级，3级。
使用国家健康保险服务的索赔和健康筛查数据，分析2003年1月1日至2021年12月31日期间接受ACL重建的患者。分析肥胖与ACL重建翻修风险以及骨关节炎或半月板损伤的额外手术治疗之间的关联。采用体重指数（BMI）将患者分类为体重过轻（BMI，<18.5）、正常体重（BMI，18.5 - 24.9）、超重（BMI，25.0 - 29.9）、肥胖（BMI，30.0 - 39.9）或病态肥胖（BMI，≥40.0）。进行多变量Cox比例风险模型分析。
共纳入56734例患者。其中，311例（0.5%）患者体重过轻，26613例（46.9%）患者体重正常，24372例（43.0%）患者超重，5324例（9.4%）患者肥胖，114例（0.2%）患者病态肥胖。体重过轻组ACL重建翻修风险显著低于正常体重组（风险比[HR]，0.54；95%置信区间[CI]，0.31 - 0.93；P = 0.0273）。然而，超重、肥胖和病态肥胖组与正常体重组之间无显著差异。超重（HR，1.93；95% CI，1.70 - 2.19；P < 0.0001）和肥胖（HR，2.71；95% CI，2.23 - 3.30；P < 0.0001）组进行高位胫骨截骨术（HTO）或全膝关节置换术（TKA）的风险显著较高。在年龄≥40岁的患者中进行的HTO风险亚组分析显示，超重组（HR, 1.889；95% CI，1.56 - 2.29；P < 0.0001）和肥胖组（HR，2.78；95% CI，2.10 - 3.69；P < 0.0001）风险显著增加。在年龄≥50岁的患者中进行的TKA风险亚组分析也显示，超重组（HR，2.03；95% CI，1.67 - 2.47；P < 0.0001）和肥胖组（HR，2.53；95% CI，1.83 - 3.50；P < 0.0001）风险显著增加。通过多变量回归分析对初次手术时的半月板损伤进行校正后，对于年龄>40岁的患者，超重和肥胖组HTO风险分别增加1.87倍和2.75倍。对于年龄>50岁的患者，超重和肥胖组TKA风险分别增加2.02倍和2.52倍。超重（HR，1.09；95% CI，1.03 - 1.15；P = 0.002）和肥胖（HR，1.10；95% CI，1.01 - 1.21；P = 0.0351）组因半月板损伤进行额外手术的风险较高，而体重过轻和病态肥胖组未发现显著差异。
本研究强调肥胖不会增加ACL重建的翻修率。然而，随着BMI增加，骨关节炎和半月板损伤的额外手术治疗风险增加。需要进一步研究以确定ACL重建对预防肥胖患者骨关节炎的疗效。
