Short-term results of combined anterior cruciate ligament and anterolateral ligament reconstruction using a novel hamstrings graft construct in obese patients: a pilot study

Background
Elevated body mass index (BMI) was associated with increased complication rates including failures in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery.
Patients and methods
We present our case series of obese patients (BMI > 30) operated for ACL reconstruction during the period from January 2017 to January 2022 using a dedicated technique for ACL reconstruction. We are using hamstring tendons prepared in a single construct to reconstruct both the intra-articular ACL and the anterolateral ligament. All patients received the same surgical technique and associated injuries were operated on according to their indications and guidelines. All patients completed the subjective knee evaluation form of the International Knee Documentation Committee at the time of the procedure and at the last follow-up visit and assessment of knee laxity was performed using a KT-1000 arthrometer before the surgery and at the last follow-up.
Results
Twenty patients underwent anterior cruciate ligament reconstruction (ACLR) using this technique during the study period, with average follow-up period of 1 year. All cases were males, mean BMI was 32.2 (30.4–36.2), 18 cases were operated on using ipsilateral Semitendinosus and Gracilis grafts, 2 cases were operated on using contralateral knee hamstrings. All cases were instructed nonweight bearing for 6 weeks after surgery and received the same standard accelerated rehabilitation protocol. Two cases developed postoperative superficial wound infection at the graft harvest site that resolved with conservative treatment of oral antibiotics and wound care. The mean postoperative International Knee Documentation Committee score improved from 45.195 to 79.245 (P<0.001), and the mean KT-1000 arthrometer differential improved from 11.8 to 2.77 (P<0.001) and pivot shift tests were negative in the postoperative exam for all the cases.
Conclusion
ACLR in obese patients should be approached with care, our technique can offer a feasible solution to obtain an acceptable outcome, Further work is required to provide insight on the long-term outcome of ACLR in obese patients.