Osteoarthritis in morbidly obese children and adolescents, an age-matched controlled study.
OBJECTIVE
Main objective of this study was to investigate the association of pain and early cartilage lesions in morbidly obese children and adolescents.


METHODS
A total of 57 subjects were included in the study. Morbidly obese patients (n = 39) were subdivided into two groups: Group A: (11 males and 9 females, 14.2 ± 2.7 years) with permanent knee pain; and Group B: (10 males and 9 females, 14.4 ± 2.2 years) without permanent or without any knee pain. Group C (8 males and 10 females, 15.0 ± 2.9 years) included age-matched children and adolescents of normal weight. MRI examinations were performed in all subjects, and an extensive analysis of the images was conducted according to the condition of the cartilage surface and the meniscus. Patients' subjective health was assessed by means of four well-known knee scores (IKDC, KOOS, Tegner/Lysholm, and VAS). Nonparametric Jonckheere-Terpstra test was used to test the trend of the natural order between the three groups.


RESULTS
In 38 of 39 morbidly obese children and adolescents, in at least one region of the knee, a marked cartilage lesion could be shown by MRI. Group A showed significantly (p < 0.001) more cartilage lesions (mean 3.7) compared to Group B (mean 2.8) and Group C (mean 0.8). IKDC, and all the KOOS subunits, showed significantly (p < 0.001, p Bonferroni < 0.001) increasing scores from Group A to B to C, in addition to KOOS symptoms.


CONCLUSIONS
Morbid obesity causes early lesions of the knee cartilage, even in young patients. Significantly, more patients with reported pain show more severe damages.
Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. harald.widhalm@meduniwien.ac.at.
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Widhalm
Department of Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria. rudolf.seemann@meduniwien.ac.at.
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Seemann
Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. martina.hamboeck@aon.at.
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Hamboeck
Department of Medical Statistics, Medical University of Vienna, Vienna, Austria. martina.mittlboeck@meduniwien.ac.at.
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Mittlboeck
Department of Radiology, Private Hospital Rudolfinerhaus, Vienna, Austria. a.neuhold@rudolfinerhaus.at.
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Neuhold
Department of Radiology, Medical University of Vienna, Vienna, Austria. klaus.friedrich@meduniwien.ac.at.
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Friedrich
Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. stefan.hajdu@meduniwien.ac.at.
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Hajdu
Department of Pediatrics, Paracelsus Private Medical University, Salzburg, Austria. kwidhalm@gmx.at.
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Widhalm
D000293:Adolescent; D018771:Arthralgia / Q000209:etiology; D002358:Cartilage, Articular / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology*; D065466:Lysholm Knee Score; D008279:Magnetic Resonance Imaging; D008297:Male; D016555:Matched-Pair Analysis; D009767:Obesity, Morbid / Q000150:complications*; D020370:Osteoarthritis, Knee / Q000473:pathology*; D064232:Visual Analog Scale
Cartilage lesions; Children; Meniscus lesions; Morbid obesity; Pain