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Functional outcomes after Medial Patellofemoral Ligament Reconstruction show inverted J-shaped relation with Body Mass Index

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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/m2 (mean age 23y, mean BMI 24) of which 7 patients (12.3%) required additional surgery. A further 36 patients had a BMI > 30 kg/m2 (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.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, SY10 7AG, UK

    N. Sharma, L. Al-Mouazzen, J. H. Kuiper, P. Gallacher & A. Barnett

  2. 28 Buckingham Road, Penn, Wolverhampton, WV4-5TJ, UK

    N. Sharma

  3. Keele University, Stoke-on-Trent, UK

    J. H. Kuiper

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  1. N. Sharma
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  2. L. Al-Mouazzen
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  3. J. H. Kuiper
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  4. P. Gallacher
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  5. A. Barnett
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Contributions

NS data collection and writing up the paper. A-M data collection, JHK statistical analysis, proof reading. PDG, AJB proof reading.

Corresponding author

Correspondence to N. Sharma.

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Ethical approval was obtained 2021_043 and stated in the methodology.

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Sharma, N., Al-Mouazzen, L., Kuiper, J.H. et al. Functional outcomes after Medial Patellofemoral Ligament Reconstruction show inverted J-shaped relation with Body Mass Index. Knee Surg Sports Traumatol Arthrosc 31, 3381–3389 (2023). https://doi.org/10.1007/s00167-023-07391-2

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