SURGICAL MANAGEMENT OF PATELLAR INSTABILITY IN ADOLESCENTS WITH BODY MASS INDEX GREATER THAN 30

Abstract

Background:

Recurrent patellar instability is a common condition often requiring surgical stabilization in adolescents. Obesity, defined as body mass index (BMI) greater than 30 kg/m² in adults, has been associated with poorer outcomes with many procedures including ACL reconstruction, spinal fusion, and joint arthroplasty. Data is limited regarding the results of surgery for patellar instability in adolescent patients with BMI > 30 kg/m².

Purpose:

The purpose of this study was to report on rates of recurrent patellar instability following surgical management in adolescents with BMI >30 kg/m² and to compare the rates of recurrent instability between different surgical procedures.

Methods

A retrospective review of patients who underwent surgical management of patellar instability at our institution was performed. Inclusion criteria included patients aged 19 and younger, with BMI >30 kg/m² who were followed for least 12 months post procedure. Patients with underlying collagen or systemic disorders, a history of prior ipsilateral knee surgery, or an osteochondral fragment greater than 10mm were excluded. Complications were defined as any recurrent subluxation or dislocation, or need for subsequent instability surgery. A subgroup analysis was performed to compare recurrent instability rates within our cohort between patients who underwent medial retinacular plication versus all other procedures. Categorical variables were compared using Fisher’s exact test. Statistical significance of p<0.05 was applied.

Results:

Fifty-five patients were identified. Mean age was 15.6±2.4 years. Mean BMI for this cohort was 34.9± 4.3 kg/m². 72.7% of patients were female. All patients underwent either medial retincular plication, tibial tubercle osteotomy, MPFL reconstruction or combined procedures (Table 1). At a mean of 3.8 years, 16.4% of all patients had any recurrent subluxation or dislocation including 12.7% who had a recurrent dislocation, and 7.3% who required a revision patellar stabilization procedure. Subgroup analysis revealed that obese patients who underwent isolated medial retinacular plication had higher rates of recurrent subluxation or dislocation (24% vs 10%, p=0.272) including recurrent dislocation (20% vs 6.7%, 0.226), and had significantly higher rates of subsequent instability surgery (16% vs 0%, p=0.037) (Table 2).

Conclusion:

Adolescents with BMI > 30 who undergo patellar stabilization surgery have notable rates of recurrent subluxation or dislocation and subsequent instability surgery though comparable to results in non-obese patients. Obese patients who underwent medial retinacular plication had higher rates of postoperative instability and significantly higher rates of revision instability surgery compared to those who underwent MPFL reconstruction, tibial tubercle osteotomy or combined procedures.