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Weak associations between body mass index and self-reported disability in people with unilateral anterior cruciate ligament reconstruction

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

Abstract

Purpose and hypothesis

Individuals with an anterior cruciate ligament reconstruction (ACLR) are susceptible to persistent disability, weight gain and the development of knee osteoarthritis. It remains unclear whether body mass index (BMI) is a factor that influences disability following ACLR. The purpose of this study was to determine the association between BMI and self-reported disability [International Knee Documentation Committee (IKDC) Index] in individuals with a unilateral ACLR. We hypothesized that lower BMI would associate with higher IKDC.

Methods

BMI and IKDC were measured in 668 individuals with a unilateral ACLR (60.9% female, BMI 24.4 ± 3.7 kg/m2, IKDC 84.7 ± 11.9%). Bivariate associations were conducted between BMI and IKDC for the entire sample and selected subsets (gender, ACLR graft type and history of meniscal injury). Multiple regression analyses were used to determine the impact of potential covariates (Tegner score, age and months since ACLR) for significant bivariate associations. After accounting for covariates, there were no significant associations between BMI and IKDC when separately evaluating the cohort based on either gender or history of a concomitant meniscal injury. The odds of achieving age- and gender-matched healthy population average IKDC scores for those with low (<25) and high (≥25) BMI were determined.

Results

Lower BMI associated with higher IKDC (r = −0.08, P = 0.04). For the entire sample, BMI did not uniquely predict variance in IKDC (ΔR 2 > 0.001, n.s.) after accounting for covariates. BMI uniquely predicted a significant but negligible amount of variance in IKDC in individuals with a patellar tendon autograft (ΔR 2 = 0.015, n.s.). Individuals with low BMI demonstrated higher odds (odds ratio = 1.45; 1.05–1.99) of achieving population average IKDC scores compared to participants with high BMI.

Conclusions

There was a significant but negligible correlation between lower BMI and lesser disability in individuals with unilateral ACLR and individuals who are underweight or of normal BMI demonstrated higher odds of achieving population average IKDC scores compared to overweight or obese individuals. While an overall association was found between lower BMI and lesser disability, the magnitude of the association remains negligible; therefore, BMI was not a strong clinical predictor of successful ACLR outcomes in this cohort of patients with unilateral ACLR.

Level of evidence

Cross-sectional prognostic study, Level II.

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Fig. 1

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

BMI:

Body mass index

IKDC:

International Knee Documentation Committee

KOA:

Knee osteoarthritis

PT:

Patellar tendon

PTOA:

Post-traumatic osteoarthritis

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Author information

Authors and Affiliations

  1. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Fetzer Hall, 210 South Rd, Chapel Hill, NC, 27514, USA

    Brian Pietrosimone, J. Troy Blackburn, Darin A. Padua & Hope Davis

  2. Department of Kinesiology, Michigan State University, IM Sports Circle Building, 308 W. Circle Drive, Room 134, East Lansing, MI, 48824, USA

    Christopher Kuenze

  3. Department of Kinesiology, University of Virginia, 405 Emmet Street, Charlottesville, VA, 22904, USA

    Joseph M. Hart

  4. ATI Physical Therapy, 200 Patewood Dr, Ste C150, Greenville, SC, 29615, USA

    Charles Thigpen

  5. Department of Kinesiology, University of Connecticut, 2095 Hillside Rd, U-1110, Storrs, CT, 06269, USA

    Adam S. Lepley

  6. Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE, 68178, USA

    Terry Grindstaff

  7. Department of Kinesiology, University of Wisconsin- Madison, Madison, WI, USA

    David Bell

  8. Department of Orthopaedics and Rehabilitation, University of Wisconsin- Madison, Unit II Gym, 2000 Observatory Drive, Madison, WI, 53706-1121, USA

    David Bell

  9. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA

    Brian Pietrosimone

Authors
  1. Brian Pietrosimone
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  2. Christopher Kuenze
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  9. Hope Davis
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  10. David Bell
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Corresponding author

Correspondence to Brian Pietrosimone.

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Conflict of interest

Authors declare that they have no conflict of interest.

Funding

The National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (1R03AR066840-01A1; BP), National Athletic Trainers Association Research and Education Foundation (#14NewInv001, BP), American Orthopaedic Society for Sports Medicine (JMH), the Mid-Atlantic Training Association (JMH), Department of Defense (JTB), University of Wisconsin Graduate School, Sports Medicine Classic Fund (DB), and the Virginia Horne Henry Fund for Women’s Physical Education (DB) supported the research in this publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of funding organizations.

Ethical approval

The data to be used for research purposes which were approved by the institutional review boards at each institution (University of Wisconsin—Madison 2013-1429; University of Toledo 107707, 106685; Michigan State University 15-971; University of Virginia HSR-17399, HSR-16997, HSR-15990, HSR-16849, HSR-17486; University of North Carolina at Chapel Hill 13-2385, 13-3228, 15-1003; Greenville Health System [South Carolina] Pro00041492).

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All participants included in the current study provided informed written consent.

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Pietrosimone, B., Kuenze, C., Hart, J.M. et al. Weak associations between body mass index and self-reported disability in people with unilateral anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 1326–1334 (2018). https://doi.org/10.1007/s00167-017-4663-y

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  • DOI: https://doi.org/10.1007/s00167-017-4663-y

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