{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:04:25Z","timestamp":1790139865501,"version":"4.0.1"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study was to examine the relationship between obesity and postoperative stiffness following surgical management of multiligamentous knee injuries (MLKIs) using a large two\u2010center cohort, by both 1) using binary cutoffs at various body mass indexes (BMIs) and 2) a linear regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      190 consecutive patients who underwent surgical management of MLKIs between January 2001 and March 2020 were reviewed at two level 1 academic trauma centers. Patient demographics, surgical characteristics, and manipulation under anesthesia (MUA)\/lysis of adhesions (LOA) were reviewed. Patients were stratified by obesity grades: grade 1 (BMI 30 to &lt;35) grade 2 (BMI 35 to &lt;40); grade 3 (BMI &gt;40), and compared with a nonobese comparison group with BMI &lt;30. Multivariate logistic regressions were performed, including the covariates of age, gender, BMI, acute versus chronic injury, external fixator, vascular injury, knee dislocation, and Schenck Classification. Fisher\u2019s exact test was used to compare rate of MUA between grades of obesity. Analyses were performed with R. Statistical significance was set at\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean BMI of the cohort was 29.2 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . The mean overall follow\u2010up was 27.2 \u00b1 7.2 months (range: 14\u2013142 months). There were 55 (29.1%) MUA procedures observed at a mean 3.77 \u00b1 2.18 months (range: 1.8\u20139.7 months) after final MLKI surgery. No significant difference was found in BMI of patients who underwent a MUA compared to patients who did not (30.2 vs 28.8;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .67). There was no significant difference in rate or time to MUA following MLKI surgery between groups, with logistic regression demonstrating no significance (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .144). Use of external fixation at the index surgery (OR\u00a0= 3.3 [95% CI: 2.2, 4.7;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .0001]) and vascular injury (OR\u00a0= 6.2 [95% CI: 1.8, 24.5;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .005]) were found to be independent predictors for need for MUA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No difference in risk for postoperative stiffness requiring MUA following surgery for MLKI was found based on BMI. At all BMI levels, there were no significant increase in need for postoperative MUA, suggesting at minimum a neutralizing effect of obesity on postoperative stiffness. In addition, patients with external fixator use and vascular injury at index surgery were found to be at significantly higher risk for postoperative stiffness requiring MUA following surgery for MLKI. Surgeons should be aware of the risk factors for arthrofibrosis when proceeding with surgical repair or reconstruction of two or more ligaments of the knee.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III, multicenter retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2022.06.017","type":"journal-article","created":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T20:57:31Z","timestamp":1656449851000},"page":"3175-3181","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":22,"title":["Risk of Postoperative Stiffness Following Multiligamentous Knee Injury Surgery Is Not Affected by Obesity: A Multicenter Study"],"prefix":"10.1002","volume":"38","author":[{"given":"Andrew S.","family":"Bi","sequence":"first","affiliation":[{"name":"New York University Langone Health Orthopedic Surgery Division of Sports Medicine New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Mojica","sequence":"additional","affiliation":[{"name":"New York University Langone Health Orthopedic Surgery Division of Sports Medicine New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle H.","family":"Markus","sequence":"additional","affiliation":[{"name":"New York University Langone Health Orthopedic Surgery Division of Sports Medicine New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Blaeser","sequence":"additional","affiliation":[{"name":"New York University Langone Health Orthopedic Surgery Division of Sports Medicine New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kahan","sequence":"additional","affiliation":[{"name":"Yale School of Medicine Department of Orthopaedics and Rehabilitation New Haven Connecticut U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Moran","sequence":"additional","affiliation":[{"name":"Yale School of Medicine Department of Orthopaedics and Rehabilitation New Haven Connecticut U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laith M.","family":"Jazrawi","sequence":"additional","affiliation":[{"name":"New York University Langone Health Orthopedic Surgery Division of Sports Medicine New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Medvecky","sequence":"additional","affiliation":[{"name":"Yale School of Medicine Department of Orthopaedics and Rehabilitation New Haven Connecticut U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Alaia","sequence":"additional","affiliation":[{"name":"New York University Langone Health Orthopedic Surgery Division of 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