Summary

Patients with elevated BMI were much more likely to require additional surgery in the setting of primary ACL reconstruction and this risk correlates with increasing BMI.

Abstract

Introduction

Despite public recognition, obesity is a growing epidemic affecting an estimated 34% of adults and 20% of children in the U.S. population. As such, the number of ACL reconstructions performed in the obese population is likely to increase. The goal of this study is to evaluate the risk that increasing BMI poses for additional surgery at the time of ACL reconstruction.

Methods

A retrospective analysis of the American College of Surgeons’ National Surgical Quality Improvement Program’s (ACS-NSQIP) database for the years 2005-2015 was conducted. Logistic regressions were used to assess the relationship between BMI and additional CPT codes for internal derangement at the time of ACL reconstruction. Internal derangement was defined as any CPT code for treatment of a meniscus tear, chondral lesion, or loose body removal. Surgeries for multi-ligamentous knee injuries were excluded.

Results

A total of 11,403 patients undergoing ACL reconstruction were identified. 41.9% of patients had an associated CPT code for internal derangement. As BMI increased, there was a corresponding increase in the odds of additional surgery. Specifically, for every 1.0 increase in BMI, the risk of additional surgery increased by 1.6% (p < 0.001). Compared to patients with a BMI of 18.5-24.9, those with a BMI 25-29.9 had an odds ratio (OR) of 1.112, BMI 30-34.9 had an OR of 1.137, BMI 35-39.9 had an OR of 1.249, and those = 40 had an OR of 1.442 for additional surgery (p < 0.001).

CONCULSIONS: Patients with elevated BMI were much more likely to require additional surgery in the setting of primary ACL reconstruction and this risk correlates with increasing BMI. As more patients elect to undergo ACL reconstruction, surgeons must critically evaluate and prepare for the potential need for additional procedures.