Elevated BMI increases concurrent pathology and operative time in adolescent ACL reconstruction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Adolescent anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure.
• Concurrent surgical pathology can complicate ACL reconstruction and affect outcomes.
• The impact of patient factors like body mass index (BMI) on surgical complexity and duration is an area of ongoing research.

Purpose of the Study:

• To determine the incidence of concurrent surgical pathology during adolescent ACL reconstruction.
• To identify patient risk factors associated with concurrent intra-articular knee pathology.
• To assess the influence of body mass index (BMI) on operative time in this patient population.

Main Methods:

• Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database (2005-2017).
• Inclusion of 917 patients aged 18 years or younger undergoing ACL reconstruction (CPT code 29888), excluding multi-ligament injuries.
• Logistic and linear regression models were used to evaluate the relationship between BMI and concurrent internal derangement procedures, as well as operative time.

Main Results:

• A significant proportion (43.7%) of adolescent ACL reconstructions required additional procedures for internal derangement (meniscal tears, chondral lesions, loose bodies).
• Each one-point increase in BMI correlated with a 3.1% increased risk of requiring additional procedures for internal derangement.
• BMI was independently predictive of longer operative times, with nearly one minute added per BMI point.

Conclusions:

• Adolescent patients undergoing ACL reconstruction with elevated BMI have a substantially higher likelihood of requiring concurrent surgical procedures for internal derangement.
• Body mass index is a significant predictor of increased operative time in adolescent ACL reconstruction surgery.
• These findings highlight the importance of considering BMI in surgical planning and resource allocation for adolescent ACL reconstructions.