Knee Arthroscopy in Morbidly Obese Patients: Perioperative Challenges and Technical Considerations to Optimize...

Obesity is an increasing global health burden and a significant contributor to knee joint pathology. Arthroscopic knee surgery in morbidly obese patients poses unique perioperative challenges that may influence surgical safety and functional outcomes.

The aim of the study was to identify key perioperative challenges encountered during arthroscopic knee surgery in morbidly obese patients and to describe practical, reproducible technical adaptations that facilitate safe and effective arthroscopy in this high-risk population.

A retrospective review was conducted on 50 morbidly obese patients (body mass index [BMI] ≥35 kg/m2) who underwent arthroscopic knee surgery between January 2021 and December 2024. Demographic data, comorbidities, anesthetic and intraoperative adaptations, and functional outcomes using the Tegner-Lysholm score were analyzed.

The mean patient age was 33.60 ± 11.30 years, with a mean BMI of 40.23 ± 6.67 kg/m2. Anterior cruciate ligament-related procedures were the most common indication (44%). General anesthesia was used in 92% of cases, and obesity-specific operating tables were required in 44%. At a mean follow-up of 19 months, Tegner-Lysholm scores improved significantly from 65.44 ± 13.10 preoperatively to 85.26 ± 10.59 postoperatively (P < 0.001). Perioperative challenges included anesthetic preparation and airway management, patient positioning, accurate portal and tunnel placement, joint manipulation during meniscal procedures, and post-operative rehabilitation.

Arthroscopic knee surgery in morbidly obese patients is technically demanding but can provide substantial functional improvement when perioperative challenges are anticipated and addressed through appropriate surgical and anesthetic modifications.