It is widely accepted that intra-articular graft reconstruction with correct placement stands the greatest chance of abolishing symptomatic instability secondary to anterior cruciate ligament (ACL) deficiency. It is estimated that at least 100,000 ACL reconstructions are performed a year in the USA, where approximately 30% of the population are currently clinically obese. In the UK obesity is a growing problem and as participation in exercise is seen as an important part of the strategy in improving the health of the nation, it is likely that there will be an increasing number of ligament injured patients from this sub group. Does obesity prejudice outcome? There is very little published work on this association of obesity and ligament reconstruction. It has been reported that subjects with a BMI greater than 30 have 0.35 times the odds of success as subjects with a normal BMI. We know the strains placed across the ACL in activities of daily living and the fixation strengths of most of the commonly used ACL reconstruction methods. Using mathematical modeling we can predict likely limits in patient BMI for the materials and rehabilitation regimens in common practice. The theoretical point where BMI is likely to prejudice outcome and cause early graft failure can be calculated. This has implications for patient selection, producing a procedure of limited clinical value. Mathematical modelling can also show the potential problems with weight gain in patient groups after successful ACL reconstruction. Can ACL reconstruction be justified in the obese?Introduction
Methods
Hamstring tendons are commonly used for Anterior Cruciate Ligament (ACL) reconstruction. In our series of 100 consecutive Hamstring ACL reconstructions, a four-strand graft was less than 7.0 mm in 5 patients. The aim of this study was to develop a screening test to assess the size of the hamstring tendon and so aid in the pre operative planning and patient counselling especially if hamstring size was deemed to be inadequate. A retrospective study of 100 consecutive hamstring ACL reconstructions analysed the correlation of the tendon size to height, weight and body mass index. A prospective double blind study was also set up involving independent observations by a musculoskeletal radiologist and the lead Orthopaedic surgeon. There was no correlation between the anthropometric measures and hamstring size in the retrospective study. A total of 27 limbs were assessed sonographically, in 26 patients. Spearman's rank correlation coefficient was found to Pearson's r = 0.0786; p = 0.715. Pre-operative anthropometric measures and Ultrasound could not be used as a screening test to detect inadequate hamstrings in the clinical setting.Result
Conclusion
