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Adipose-to-muscle area ratio at the knee is superior to BMI in predicting post-operative outcome following arthroscopic meniscectomy

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

To determine if measurement of leg adipose tissue area by MRI is a better predictor of post-operative clinical outcome compared to body mass index (BMI) following arthroscopic meniscectomy.

Methods

Patients that underwent an arthroscopic partial meniscectomy between 2011 and 2016 were identified and a retrospective chart review was performed. Patients with additional knee pathology other than a meniscal tear with or without associated articular cartilage injury were excluded. Leg adipose tissue and muscle area measurements at the level of the knee joint were performed for patients on their preoperative axial magnetic resonance imaging (MRI) study and adipose-to-muscle area ratio (AMR) was calculated. Correlations among AMR, BMI, and post-operative clinical outcomes were compared.

Results

A total of 74 patients (32 females and 42 males) were included (mean age 50.0 years, std. dev. 12.3 years). 35 patients underwent a partial medial meniscectomy, 15 underwent a partial lateral meniscectomy, and 24 underwent both. Linear regression analysis showed that the AMR, compared to BMI, had a significantly stronger correlation to both mean post-operative Knee Injury and Osteoarthritis Outcome Score (KOOS) across all 5 subscales (KOOS5) and Tegner Current score. Patients that had cartilage damage and concurrent chondroplasty tended to be older and have lower post-operative KOOS5 compared to those with no cartilage damage. AMR was also significantly correlated to age and BMI.

Conclusions

The current study demonstrates that compared to BMI, leg adiposity as determined by the ratio of adipose tissue to muscle area on axial MRI (AMR), is a stronger predictor of functional outcome following meniscectomy. This suggests a role of obesity in the progression of OA beyond the increased joint forces associated with increased BMI.

Level of evidence

IV, retrospective case series.

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References

  1. Haviv B, Bronak S, Thein R (2015) Correlation between body mass index and chondral lesions in isolated medial meniscus tears. Indian J Orthop 49(2):176–180. https://doi.org/10.4103/0019-5413.152456

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ogden CL, Carroll MD, Fryar CD, Flegal KM (2015) Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief 219:1–8

  3. Shah NR, Braverman ER (2012) Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin. PLoS One 7(4):e33308. https://doi.org/10.1371/journal.pone.0033308

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kluczynski MA, Bisson LJ, Marzo JM (2014) Does body mass index affect outcomes of ambulatory knee and shoulder surgery? Arthroscopy 30(7):856–865. https://doi.org/10.1016/j.arthro.2014.02.031

    Article  PubMed  Google Scholar 

  5. Erdil M, Bilsel K, Sungur M, Dikmen G, Tuncer N, Polat G, Elmadag NM, Tuncay I, Asik M (2013) Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study. Arthroscopy 29(2):232–237. https://doi.org/10.1016/j.arthro.2012.08.017

    Article  PubMed  Google Scholar 

  6. Sofu H, Oner A, Camurcu Y, Gursu S, Ucpunar H, Sahin V (2016) Predictors of the clinical outcome after arthroscopic partial meniscectomy for acute trauma-related symptomatic medial meniscal tear in patients more than 60 years of age. Arthroscopy 32(6):1125–1132. https://doi.org/10.1016/j.arthro.2015.11.040

    Article  PubMed  Google Scholar 

  7. Salata MJ, Gibbs AE, Sekiya JK (2010) A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med 38(9):1907–1916. https://doi.org/10.1177/0363546510370196

    Article  PubMed  Google Scholar 

  8. Bailey O, Gronkowski K, Leach WJ (2015) Effect of body mass index and osteoarthritis on outcomes following arthroscopic meniscectomy: a prospective nationwide study. Knee 22(2):95–99. https://doi.org/10.1016/j.knee.2014.12.008

    Article  CAS  PubMed  Google Scholar 

  9. Thijssen E, van Caam A, van der Kraan PM (2015) Obesity and osteoarthritis, more than just wear and tear: pivotal roles for inflamed adipose tissue and dyslipidaemia in obesity-induced osteoarthritis. Rheumatology 54(4):588–600. https://doi.org/10.1093/rheumatology/keu464

    Article  CAS  PubMed  Google Scholar 

  10. Liu P, Ma F, Lou H, Liu Y (2013) The utility of fat mass index vs. body mass index and percentage of body fat in the screening of metabolic syndrome. BMC Public Health 13:629. https://doi.org/10.1186/1471-2458-13-629

    Article  PubMed  PubMed Central  Google Scholar 

  11. Santos DA, Silva AM, Matias CN, Magalhaes JP, Minderico CS, Thomas DM, Sardinha LB (2015) Utility of novel body indices in predicting fat mass in elite athletes. Nutrition 31(7–8):948–954. https://doi.org/10.1016/j.nut.2015.02.003

    Article  PubMed  Google Scholar 

  12. Collins NJ, Prinsen CA, Christensen R, Bartels EM, Terwee CB, Roos EM (2016) Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthr Cartil 24(8):1317–1329. https://doi.org/10.1016/j.joca.2016.03.010

    Article  CAS  Google Scholar 

  13. Briggs KK, Kocher MS, Rodkey WG, Steadman JR (2006) Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 88(4):698–705. https://doi.org/10.2106/JBJS.E.00339

    Article  PubMed  Google Scholar 

  14. Blazek K, Favre J, Asay J, Erhart-Hledik J, Andriacchi T (2014) Age and obesity alter the relationship between femoral articular cartilage thickness and ambulatory loads in individuals without osteoarthritis. J Orthop Res 32(3):394–402. https://doi.org/10.1002/jor.22530

    Article  PubMed  Google Scholar 

  15. Maffiuletti NA, Jubeau M, Munzinger U, Bizzini M, Agosti F, De Col A, Lafortuna CL, Sartorio A (2007) Differences in quadriceps muscle strength and fatigue between lean and obese subjects. Eur J Appl Physiol 101(1):51–59. https://doi.org/10.1007/s00421-007-0471-2

    Article  PubMed  Google Scholar 

  16. Himes CL, Reynolds SL (2012) Effect of obesity on falls, injury, and disability. J Am Geriatr Soc 60(1):124–129. https://doi.org/10.1111/j.1532-5415.2011.03767.x

    Article  PubMed  Google Scholar 

  17. Bhasin S, Travison TG, Storer TW, Lakshman K, Kaushik M, Mazer NA, Ngyuen AH, Davda MN, Jara H, Aakil A, Anderson S, Knapp PE, Hanka S, Mohammed N, Daou P, Miciek R, Ulloor J, Zhang A, Brooks B, Orwoll K, Hede-Brierley L, Eder R, Elmi A, Bhasin G, Collins L, Singh R, Basaria S (2012) Effect of testosterone supplementation with and without a dual 5alpha-reductase inhibitor on fat-free mass in men with suppressed testosterone production: a randomized controlled trial. JAMA 307(9):931–939. https://doi.org/10.1001/jama.2012.227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Harrison MM, Morrell J, Hopman WM (2004) Influence of obesity on outcome after knee arthroscopy. Arthroscopy 20(7):691–695. https://doi.org/10.1016/j.arthro.2004.06.004

    Article  PubMed  Google Scholar 

  19. Spahn G, Muckley T, Kahl E, Hofmann GO (2006) Factors affecting the outcome of arthroscopy in medial-compartment osteoarthritis of the knee. Arthroscopy 22(11):1233–1240. https://doi.org/10.1016/j.arthro.2006.07.003

    Article  PubMed  Google Scholar 

  20. Dervin GF, Stiell IG, Rody K, Grabowski J (2003) Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life. J Bone Joint Surg Am 85-A(1):10–19

    Article  Google Scholar 

  21. Fabricant PD, Rosenberger PH, Jokl P, Ickovics JR (2008) Predictors of short-term recovery differ from those of long-term outcome after arthroscopic partial meniscectomy. Arthroscopy 24(7):769–778. https://doi.org/10.1016/j.arthro.2008.02.015

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rosenberger PH, Dhabhar FS, Epel E, Jokl P, Ickovics JR (2010) Sex differences in factors influencing recovery from arthroscopic knee surgery. Clin Orthop Relat Res 468(12):3399–3405. https://doi.org/10.1007/s11999-010-1562-7

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kaneko S, Satoh T, Chiba J, Ju C, Inoue K, Kagawa J (2000) Interleukin-6 and interleukin-8 levels in serum and synovial fluid of patients with osteoarthritis. Cytokines Cell Mol Ther 6(2):71–79

    Article  CAS  PubMed  Google Scholar 

  24. Brenn D, Richter F, Schaible HG (2007) Sensitization of unmyelinated sensory fibers of the joint nerve to mechanical stimuli by interleukin-6 in the rat: an inflammatory mechanism of joint pain. Arthritis Rheum 56(1):351–359. https://doi.org/10.1002/art.22282

    Article  CAS  PubMed  Google Scholar 

  25. Ateschrang A, Eggensperger F, Ahrend MD, Schroter S, Stockle U, Kraus TM (2018) Obesity causes poorer clinical results and higher re-tear rates in rotator cuff repair. Arch Orthop Trauma Surg 138(6):835–842. https://doi.org/10.1007/s00402-018-2921-1

    Article  CAS  PubMed  Google Scholar 

  26. Singer SP, Dammerer D, Krismer M, Liebensteiner MC (2018) Maximum lifetime body mass index is the appropriate predictor of knee and hip osteoarthritis. Arch Orthop Trauma Surg 138(1):99–103. https://doi.org/10.1007/s00402-017-2825-5

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA

    Amos Z. Dai

  2. NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA

    Joshua Breite, Hien Pham, Michael Pickell, Mark Kramarchuk, Eduardo Vaca & Eric J. Strauss

  3. Staten Island, USA

    Amos Z. Dai

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  1. Amos Z. Dai
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  2. Joshua Breite
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Correspondence to Amos Z. Dai.

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Ethical approval was obtained from the authors’ Institutional Review Board (s-17-01185).

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Waiver of authorization and consent was approved by the authors’ Institutional Review Board due to the retrospective nature of the study.

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Dai, A.Z., Breite, J., Pham, H. et al. Adipose-to-muscle area ratio at the knee is superior to BMI in predicting post-operative outcome following arthroscopic meniscectomy. Arch Orthop Trauma Surg 139, 355–360 (2019). https://doi.org/10.1007/s00402-018-3030-x

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  • DOI: https://doi.org/10.1007/s00402-018-3030-x

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