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MRI analysis of peripheral soft tissue composition, not body mass index, correlates with outcomes following anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To utilize MRI to assess the relationship between BMI, peripheral soft tissue composition about the knee, and surgical outcomes in patients undergoing primary ACL reconstruction. It was hypothesized that a fatty periarticular soft tissue composition may be better than BMI at predicting poor outcomes after ACL reconstruction.

Methods

Fifty-eight patients who underwent primary acute ACL reconstruction were identified from the surgical database and their data were retrospectively reviewed. Patients were selected based on availability of 2-year IKDC outcome scores, BMI data, and preoperative MRI studies. To approximate peripheral soft tissue composition, novel measurements of axial MRI images were employed using PACS ROI measurement tool. Relationships were assessed between IKDC outcome scores and measures of body habitus including BMI, total knee area, knee fatty-connective tissue area, and fatty-connective tissue to bone size ratio.

Results

The median BMI was 24.3 kg/m2 (range 18.5–36.9). Median IKDC score was 81.0 (range 46–100). BMI was correlated with total knee area (R = 0.72) and periarticular fat (R = 0.53). Neither continuous BMI (n.s.) nor total knee area (n.s.) was predictor of IKDC outcomes scores. Periarticular fatty-connective tissue trended towards predicting negative outcomes (n.s.). Periarticular fatty-connective tissue to bone size ratio was a significant negative predictor of IKDC scores (p = 0.03). Patients with more fat than bone on axial MRI (ratio > 1, N = 34) reported a lower mean IKDC score compared to patients with a ratio < 1 (N = 24) (77.2 vs. 87.7, p = 0.0028). The top quartile (N = 14) of these ratios reported a mean IKDC score of 68.9, compared to 87.3 of the bottom quartile (p = 0.0001).

Conclusions

Periarticular soft tissue composition, as approximated by the novel MRI analysis of this study, is a better predictor of outcomes following ACL reconstruction than is BMI. This information can be utilized in guiding surgeon and patient expectations following surgery, either via a direct application of these measurements or heightened awareness of the importance of peripheral body habitus.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E. 17th Street, 14 Floor, New York, NY, 10003, USA

    Michael T. Milone, Kartik Shenoy, Hien Pham, Laith M. Jazrawi & Eric J. Strauss

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  1. Michael T. Milone
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  2. Kartik Shenoy
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  3. Hien Pham
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  4. Laith M. Jazrawi
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  5. Eric J. Strauss
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Correspondence to Michael T. Milone.

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The authors declared that they have no conflict of interest.

Ethical approval

IRB approved by Helen Panageas, Director of NYU School of Medicine IRB. IRB#: i15-00863.

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Milone, M.T., Shenoy, K., Pham, H. et al. MRI analysis of peripheral soft tissue composition, not body mass index, correlates with outcomes following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 3711–3716 (2018). https://doi.org/10.1007/s00167-018-4966-7

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  • DOI: https://doi.org/10.1007/s00167-018-4966-7

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