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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >BMI INCREASES AFTER ACL-RECONSTRUCTION IN ADOLESCENTS
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BMI INCREASES AFTER ACL-RECONSTRUCTION IN ADOLESCENTS

机译：青少年进行ACL重建后BMI会增加

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Background: The incidence of ACL injuries in the pediatric and adolescent patient population has increased over the last 20 years. ACL reconstruction is recommended to avoid osteoarthritis later in life. However, a 6-12 months rehabilitation with no or limited sports activity after surgery is required to protect the graft and graft fixation. The aim of this study was to determine, if this period of inactivity affects the BMI in an adolescent patient population and affects patient self-reported outcomes. Methods: A retrospective review of 115 patients between the ages of 12 and 21 years, who had undergone ACL reconstruction with hamstring or bone-patellar-bone autograft by a single orthopaedic surgeon between 2013 and 2017 was performed. 44 patients had records of height and weight pre- and post-operatively (6 months, 1 year, at most recent follow-up: average 2.09 years, range 1-5.25 years). BMI was calculated using the CDC BMI calculator for child & teen or adult, depending on the age of the patient. Based on this, patients were categorized as having a normal weight, being overweight or obese. Patient self-report outcomes - PediIKDC, Tegner-Lysholm and KOOSChild - were reviewed. Data was analyzed using Student’s t-test and Spearman correlation. Results: BMI did not change in the 6 months after ACL reconstruction, but was significantly higher 1 year after ACL reconstruction and at most recent follow-up compared to BMI at initial surgery (Table 1). Sub-analysis by gender revealed that males had a higher BMI at both timepoints, whereas females only showed an increase in BMI at most recent follow-up, but not at 1 year post-surgery. While 26.1% of male patients were obese at surgery, 54.2% were obese 6 months after ACL reconstruction and 40.9% at 1 year (Figure1). At most recent follow-up, the distribution of patients in the weight categories was similar to that at initial surgery. This trend was not seen in female patients. A selection-bias for overweight and obese patients in the follow-up period can be ruled out, as obesity or overweight were not related to complications after surgery. BMI weakly correlated with better outcomes for the KOOSChild Quality of Life domain at 6 months after surgery (r=0.450, p=0.031) and trended to be weakly correlated with the KOOSChild Symptom domain (p=0.071), KOOSChild Sport domain (p=0.076) and PediIKDC (p=0.061). No correlation between BMI and patient outcomes was found at 1 year after ACL reconstruction or at most recent follow-up. Conclusion: After ACL-reconstruction, adolescents gain weight, most likely due to limited activity during the rehabilitation phase. This weight gain was more pronounced in males than females. The increase in BMI lasted longer than the period of rehabilitation-related inactivity. Patients with higher BMI rated their Quality of Life better at 6 months. The activity restrictions might not have affected these patients usual life style, however, data on activity level before ACL injury was not available. All patients @ Surgery 6 mths @ Surgery 1 year @Surgery recent FU BMI 27 3 ± 7.4 26.9 ±5.1 26.4 ±4.8 27.8 ± 5.7 26.1 ±4.8 28.3 ±5.6 p-value 0.688 & 0.005 & 0.005 N 38 39 44 Females @ Surgery 6 mths Surgery 1 year @Surgery recent FU BMI 25.3 ± 5.5 25.8 ± 5.6 25.6 ± 4.7 26.3 ± 5.0 25.8 ± 4.6 27.7 ± 5.3 p-value 0 971 0.175 0.001 N 14 17 18 Males @ Surgery 6 mths @ Surgery 1 year @Surgery recent FU BMI 28.2 ± 8.4 27.6 ± 4.8 27.1 ± 4.9 29.0 ± 6.1 26.4 ± 5.0 28.6 ± 6.0 p-valve 0.688 & 0.005 & 0.005 N 24 22 26 Mean ± SD is indicated Figure 1. Percentage of male and female patients with normal weight, overweight and obesity at and after ACL-reconstruction surgery.
机译：背景：在过去的20年中，小儿和青少年患者中ACL损伤的发生率有所增加。建议进行ACL重建，以避免以后出现骨关节炎。但是，为了保护移植物和移植物固定，需要进行6到12个月的康复治疗，且术后无运动活动或活动受限。这项研究的目的是确定这段不活动时间是否影响青春期患者群体的BMI并影响患者自我报告的结局。方法：回顾性分析2013年至2017年间115名12岁至21岁的患者，这些患者由一位整形外科医生用with绳肌或bone骨/骨自体移植进行了ACL重建。 44例患者在手术前后有身高和体重的记录（6个月零1年，最近一次随访：平均2.09年，范围1-5.25年）。使用CDC BMI计算器针对儿童，青少年或成人计算BMI，具体取决于患者的年龄。基于此，将患者归类为体重正常，超重或肥胖。回顾了患者的自我报告结局-PediIKDC，Tegner-Lysholm和KOOSChild。使用学生的t检验和Spearman相关性分析数据。结果：与最初手术时的BMI相比，ACL重建后6个月的BMI没有变化，但在ACL重建后1年和最近的随访中BMI显着更高（表1）。按性别进行的亚分析显示，在两个时间点，男性的BMI均较高，而女性仅在最近的随访中显示出BMI升高，但在手术后1年没有升高。虽然26.1％的男性患者在手术中肥胖，但ACL重建后6个月的肥胖率为54.2％，1年时的肥胖率为40.9％（图1）。在最近的随访中，体重类别患者的分布与初次手术时相似。女性患者未发现这种趋势。由于肥胖或超重与手术后的并发症无关，因此可以排除在随访期间对超重和肥胖患者的选择偏见。术后6个月，BMI与KOOSChild生活质量域的较好结局弱相关（r = 0.450，p = 0.031），并且与KOOSChild症状域（p = 0.071），KOOSChild运动域（p = 0.076）和PediIKDC（p = 0.061）。在ACL重建后1年或最近的随访中，未发现BMI与患者预后之间存在相关性。结论：ACL重建后，青少年体重增加，很可能是由于康复阶段活动受限所致。这种体重增加在男性比女性中更为明显。 BMI的持续时间长于与康复相关的不活动时间。 BMI较高的患者在6个月时的生活质量更好。活动限制可能不会影响这些患者的正常生活方式，但是，尚无ACL损伤前活动水平的数据。所有患者@外科手术6个月@外科手术1年@外科手术最近FU BMI 27 3±7.4 26.9±5.1 26.4±4.8 27.8±5.7 26.1±4.8 28.3±5.6 p值0.688＆ 0.005 ＜ 0.005 N 38 39 44女性@手术6个月手术1年@最近的手术FU BMI 25.3±5.5 25.8±5.6 25.6±4.7 26.3±5.0 25.8±4.6 27.7±5.3 p值0 971 0.175 0.001 N 14 17 18男性@手术6个月@手术1年@手术最近FU BMI 28.2±8.4 27.6±4.8 27.1±4.9 29.0±6.1 26.4±5.0 28.6±6.0 p阀0.688＆ 0.005 ＜ 0.005 N 24 22 26表示平均值±SD。图1.在ACL重建手术前后，体重，超重和肥胖正常的男性和女性患者的百分比。

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