Association of Elevated Body Mass Index and Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus

Abstract

Background: Osteochondral lesions of the talus (OLTs) are a common condition found in patients with chronic ankle pain after previous ankle sprains. Surgical management is indicated after conservative management has failed. Hypothesis/Purpose: This study evaluates the influence of body mass index (BMI) on the early clinical outcomes of arthroscopic debridement and microfracture of OLTs. Methods: A total of 252 patients with symptomatic OLTs who failed conservative management underwent arthroscopic debridement and microfracture of OLTs over the affected ankle between 2007 and 2017. Patients from this cohort were divided into 2 groups based on BMI: the normal BMI group (NB Group) (BMI 18.5-25.0) and overweight and obese BMI group (OB Group) (BMI ≥25). Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the physical and mental component summaries of the 36-Item Short-Form Health Survey (PCS and MCS, respectively) were prospectively collected from the cohort during their standard postoperative outpatient follow-up. Results: The NB Group (n=105) and OB Group (n=147) were well matched demographically. The operative duration was significantly shorter for the NB Group compared to the OB Group. Patients from both groups had significant improvements in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months after surgery ( P < .05). Between both groups, patients had comparable VAS, AOFAS, and PCS scores at preoperation, 6 months postoperation, and 24 months postoperation ( P > .05). However, MCS in the OB Group was lower at 24 months postoperatively compared with the NB Group ( P < .05). The OB Group reported better satisfaction scores (82.4% vs 72.6%, P < .05), and a greater proportion had their expectations met (88.2% vs 77.9%, P < .05). Conclusion: A BMI ≥25 was not associated with worse postoperative pain and functional outcomes, but rather was found to be associated with greater satisfaction and fulfillment. However, patients with BMI ≥25 required longer procedure duration and had poorer MCS scores at 24 months after surgery. Level of Evidence: Level III, retrospective cohort study.

Comparison of arthroscopic debridement and microfracture in the treatment of osteochondral lesion of talus

“…The BMI of patients with good/excellent joints was significantly lower than that of patients with fair and poor joints, and our analysis was based on the following two reasons: Firstly, obesity has negative physiologic and psychological impacts on patients' postoperative quality of life and affects their postoperative recovery. Secondly, obese patients have a poor prognosis for the development of degenerative joint disease, consistent with previous studies (43,44). Finally, obesity-associated behavior such as functional limitations, constant dieting, and mental stress from their body image and poor self-esteem, coupled with social stigma, all play a strong role linking obesity with depression (45).…”

“…Finally, obesity-associated behavior such as functional limitations, constant dieting, and mental stress from their body image and poor self-esteem, coupled with social stigma, all play a strong role linking obesity with depression (45). In Group B, we concluded that an elevated BMI did not adversely affect pain and function, and a high proportion of patients reported greater postoperative satisfaction and achievement, similar to other studies (44). Instead, patients should be encouraged to normalize their BMI in view of the negative impact on their quality of life and the physical limitations associated with a raised BMI.…”

The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

“… a Significantly different from osteo(chondral) autograft transplantation therapies ( Q = 7.55, P = 0.0060) and metal implants ( Q = 5.27, P = 0.0217). 43,52,59,61 -63,66,81,92,93,109,113,117,121,123,125,131,135,141,143,146,149,150,153,158,164,165,167,168,171,173,176,177,179 -183,187,190,192,195 -200,202,204 -206 b Significantly different from metal implants ( Q = 3.86, P = 0.0493). 11,42,53,56,59,116,118,137,170,…”

Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

“…The effect of BMI on clinical outcomes remains debated. A recent study by Koh et al 27 reported that a BMI of ≥25 kg/m 2 was not associated with decreased outcomes at 2 years of follow-up in 252 patients who underwent arthroscopic BMS. Indeed, the aforementioned authors found that a higher BMI appeared to be weakly associated with improved outcomes.…”