Investigating the effect of gastric sleeve surgery in patients with high BMI on patellar malt racking and pain caused by patellar chondromalacia in these patients

Abstract

Author(s): Hosein Pirmohamadi, Mohamad kazem Emami Mebodi, Hamed Gholizadeh, Saeid Roozpeykar, Ramin Ghalandarzadeh* and Mohamad Hosein Mokhtari

Introduction and Purpose: Gastric sleeve surgery is an effective intervention for the treatment of severe obesity and associated diseases. Most people with obesity will experience pain in the front of the knee over time. Thus, conducting more studies on the effect of the results of surgery to reduce BMI (Body Mass Index) on anterior knee pain caused by factors such as patellar maltracking and patellar chondromalacia will be useful for better determining appropriate treatment protocols in the future. Therefore, in this study, we will investigate the effect of sleeve surgery.

Materials and Methods: This study was conducted as a prospective cohort. The study population includes patients with high BMI who simultaneously had symptoms of anterior knee pain caused by patella chondromalacia, and in the second half of 2011, they referred to Baqiyat Elah Azam Hospital and underwent sleeve surgery. Sampling was done by census. Information such as age, gender, BMI at the time of surgery, comorbidities (rheumatoid arthritis, osteoarthritis, preoperative fractures and dislocations) and medications were collected from the patient records and recorded in the relevant checklist. Before the operation and six months after the operation, the patients underwent an examination of the lower limbs and knees in the clinic, and the patients were examined in terms of maltracking of the patella. Chondromalacia patella was also investigated by taking history and clinical examination before surgery and six months after surgery. The range of motion of the knee was measured before the operation and six months after the operation in the clinic using an orthopedic goniometer and reported according to degrees. Before the operation, axial patellar view radiographs were taken from the patients, and six months after the operation, the radiograph was repeated again and reported by a radiologist to investigate the changes related to tilt patella and the effect of surgery on it. Also, in this study, the quality of life of the patients before and six months after the operation was evaluated using a 36-question quality of life questionnaire. Finally, the obtained information was analyzed using SPSS vs. 24 statistical software.

Results: 35 patients participated in this study. The average age of the patients was 40.8 years ± 10.14 years. 11 people (31.4%) men, 24 women (68.6%) participated in this study. Only 1 patient (2.9%) had alcohol and smoking. 16 patients (45.7%) had an underlying disease, and 12 patients (34.4%) were taking medication. The average body mass index of the patients before the operation is 39.2 and six months after the operation is 30.7. The study showed that patellar mal-trecking was present in 24 patients (68.6%) before the intervention, and this number was reported in 22 patients (62.9%) after the intervention, and this difference was not significant (p>0.05). Anterior knee pain caused by chondromalacia patella based on the VAS criterion before the intervention is 7.11 ± 0.75 and after the intervention is 5.6 ± 0.69, and we saw a significant decrease in the anterior knee pain score caused by chondromalacia patella in patients after the intervention (p<0.05). . The average knee range of motion before the intervention was 102.1 ± 1.26 and after the intervention this value increased by 117.68 ± 2.09 and this increase was statistically significant (p<0.05). Before the intervention, 42.9% of people had tilt patella, and after the intervention, 37.1% of people had tilt patella. Surgical intervention had no effect on the significant reduction of tilt patella (p>0.05). 6 months after the intervention, there was a significant difference in the reduction of the VAS score after the intervention (p<0.05).

Conclusion: The result of our study showed that gastric sleeve surgery can reduce anterior knee pain caused by patellar chondromalacia and increase the range of motion of the knee joint and improve the quality of life. It also has a significant effect on patellar maltracking and patellar tilt.

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