BMI Does Not Increase Complication Rates in Medial Patellofemoral Reconstruction

Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting on April 15, 2026, indicate that patients with a body mass index (BMI) of 30 kg/m² or greater who undergo medial patellofemoral ligament (MPFL) reconstruction experience complication rates similar to those with a BMI less than 30 kg/m².

While the risk of surgical complications does not appear to increase significantly for patients with a higher BMI, the findings highlighted a disparity in subjective recovery. Patients with a BMI of 30 kg/m² or greater experienced worse patient-reported outcomes compared to patients with a BMI under 30 kg/m².

Dr. Elizabeth R. Dennis, an assistant professor in the department of orthopedics at Icahn School of Medicine at Mount Sinai Hospital, discussed the utility of BMI as a metric for surgical candidates.

BMI is a useful screening tool, but It’s an imperfect measure of obesity and most physicians recognize its limitations

Elizabeth R. Dennis, MD, MS, FAAOS

Comparative Research on MPFL Reconstruction and Obesity

The findings presented on April 15, 2026, align with several previous studies examining the safety of MPFL reconstruction in obese populations. A study published on January 5, 2023, in Arthrosc Sports Med Rehabil concluded that MPFL reconstruction in obese patients was both safe and effective, noting low complication rates and improvements in most patient-reported outcomes.

Further research presented on July 31, 2023, in Orthop J Sports Med as Poster 299, specifically evaluated complications and outcomes following isolated MPFL reconstruction. The researchers for that study had hypothesized that patients with a BMI of 30 or greater would exhibit an increased risk of complications and worse patient-reported outcomes.

Additional data from May 20, 2025, supported the conclusion that BMI does not significantly impact certain surgical risks. That report noted no significant differences in complication rates or the risk of repeat dislocation after isolated MPFL reconstruction when comparing patients with a BMI of 30 or greater to those with a lower BMI.

Clinical Implications and Patient Outcomes

The consistency across these reports suggests that obesity, as measured by a BMI of 30 kg/m² or higher, does not necessarily predispose patients to higher rates of objective surgical complications during MPFL reconstruction.

However, the distinction between objective complication rates and patient-reported outcomes remains a point of interest. While the January 5, 2023, study noted improved subjective outcomes, the results presented on April 15, 2026, suggested that the obese cohort experienced worse reported outcomes than non-obese patients.

These variations emphasize the complexity of measuring success in orthopedic reconstructions, where clinical safety—such as the absence of infection or repeat dislocation—may not always correlate perfectly with a patient’s subjective experience of their recovery.