PMID- 37036473
OWN - NLM
STAT- MEDLINE
DCOM- 20230721
LR  - 20230721
IS  - 1433-7347 (Electronic)
IS  - 0942-2056 (Linking)
VI  - 31
IP  - 8
DP  - 2023 Aug
TI  - Functional outcomes after Medial Patellofemoral Ligament Reconstruction show 
      inverted J-shaped relation with Body Mass Index.
PG  - 3381-3389
LID - 10.1007/s00167-023-07391-2 [doi]
AB  - PURPOSE: Medial patellofemoral ligament reconstruction (MPFL-R) is a recognised 
      surgical procedure for the treatment of recurrent patellofemoral instability with 
      excellent outcomes reported. The aim of this study is to determine if body mass 
      index can influence these outcomes. METHODS: This is a single-centre 
      retrospective analysis of a longitudinal patellofemoral database. Patients with 
      recurrent patellar instability, without patellar alta or severe trochlear 
      dysplasia were treated using a MPFL-R between 2015 and 2019 at The Robert Jones & 
      Agnes Hunt Orthopaedic Hospital. The clinical efficacy following surgery was 
      assessed by Kujula, International Knee Documentation Committee Score (IKDC), and 
      EuroQol-5 score (EQ-5D) at baseline and up to 26 months post-operatively; their 
      safety assessed by complication rate and requirement for further surgery. The 
      effect of Body Mass Index (BMI) on clinical outcome was analysed using linear, 
      curvilinear, and segmented models following propensity score weighting. RESULTS: 
      A total of 97 patients (97 Knees, mean age 25y) were analysed. Of these, 61 
      patients had a BMI < 30 kg/m(2) (mean age 23y, mean BMI 24) of which 7 patients 
      (12.3%) required additional surgery. A further 36 patients had a BMI > 30 kg/m(2) 
      (mean age 27y, mean BMI 36) of which 2 patients (5.6%) required additional 
      surgery. The re-dislocation rate was 0% in each BMI group. Both groups had a 
      significantly improved mean outcome following surgery, with improvements in mean 
      IKDC above the minimum clinical important differences (MCID) of 20.5. BMI had an 
      inverted J-shaped association with functional outcome, showing peak outcomes at 
      BMI of 20.5 (95% CI 18.5 to 22.4; IKDC and Kujala) or BMI of 28 (EQ-5D index). No 
      evidence for an association between BMI and complication risk was found. 
      CONCLUSION: BMI influences the functional outcomes in MPFL-R with an inverted 
      J-shaped relation, without evidence it affected the complication or 
      re-dislocation rate. In the absence of patella alta and severe trochlear 
      dysplasia, an isolated MPFL reconstruction is a safe and effective procedure to 
      treat patellar instability, with the best functional outcome in patients with a 
      BMI around 20 to 21. LEVEL OF EVIDENCE: Level III.
CI  - (c) 2023. The Author(s) under exclusive licence to European Society of Sports 
      Traumatology, Knee Surgery, Arthroscopy (ESSKA).
FAU - Sharma, N
AU  - Sharma N
AUID- ORCID: 0000-0001-8918-9871
AD  - Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, 
      UK. n-sharma@doctors.org.uk.
AD  - , 28 Buckingham Road, Penn, Wolverhampton, WV4-5TJ, UK. n-sharma@doctors.org.uk.
FAU - Al-Mouazzen, L
AU  - Al-Mouazzen L
AD  - Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, 
      UK.
FAU - Kuiper, J H
AU  - Kuiper JH
AD  - Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, 
      UK.
AD  - Keele University, Stoke-on-Trent, UK.
FAU - Gallacher, P
AU  - Gallacher P
AD  - Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, 
      UK.
FAU - Barnett, A
AU  - Barnett A
AD  - Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, 
      UK.
LA  - eng
PT  - Journal Article
DEP - 20230410
PL  - Germany
TA  - Knee Surg Sports Traumatol Arthrosc
JT  - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
JID - 9314730
SB  - IM
MH  - Humans
MH  - Adult
MH  - Young Adult
MH  - *Patellar Dislocation/surgery/complications
MH  - Body Mass Index
MH  - *Patellofemoral Joint/surgery
MH  - *Joint Instability/surgery/etiology
MH  - Retrospective Studies
MH  - *Joint Dislocations/complications
MH  - Ligaments, Articular/surgery
MH  - *Bone Diseases
MH  - Patella/surgery
OTO - NOTNLM
OT  - Body Mass Index
OT  - Medial patellofemoral ligament reconstruction
OT  - Patellofemoral instability
OT  - Trochlear dysplasia
EDAT- 2023/04/11 06:00
MHDA- 2023/07/21 06:42
CRDT- 2023/04/10 11:12
PHST- 2022/10/08 00:00 [received]
PHST- 2023/03/10 00:00 [accepted]
PHST- 2023/07/21 06:42 [medline]
PHST- 2023/04/11 06:00 [pubmed]
PHST- 2023/04/10 11:12 [entrez]
AID - 10.1007/s00167-023-07391-2 [pii]
AID - 10.1007/s00167-023-07391-2 [doi]
PST - ppublish
SO  - Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3381-3389. doi: 
      10.1007/s00167-023-07391-2. Epub 2023 Apr 10.