Body Composition, Limb Symmetry, and Functional Outcomes after ACL Injury: Insights from Sports Injury Patients in a Bangladeshi Orthopedic Department

Abstract

Background: Anterior cruciate ligament (ACL) injury is a frequent and disabling problem among sports injury patients. Body composition and muscle asymmetry are suspected risk factors, but evidence from Bangladeshi clinical populations is limited.

Objective: To investigate the association of body composition and limb symmetry with ACL injury among sports injury patients attending the Department of Orthopedic Surgery, Bangladesh Medical University.

Methods: This cross-sectional study was conducted over one year (January 2023–December 2023) and included 92 sports injury patients (74 without ACL injury; 18 with prior ACL injury). Anthropometry, bioelectrical impedance (or skinfolds), and thigh circumference/lean mass were measured, and limb symmetry indices (LSI) were calculated. In the ACL-injured subgroup, functional outcomes were assessed using KOOS (Knee injury and Osteoarthritis Outcome Score) and IKDC (International Knee Documentation Committee). Logistic regression adjusted for age, sex, sport type, and weekly training exposure examined associations, while AUC and calibration assessed model performance.

Results: Patients with ACL injury had higher body fat % (21.9 vs 18.6), lower thigh symmetry (92.4% vs 96.9%), and greater weekly exposure (9.0 vs 7.4 h). Adjusted models showed body fat % (aOR 1.42, 95% CI 1.06–2.02) and reduced thigh symmetry (aOR 0.69, 95% CI 0.50–0.95) were significant predictors, while BMI was not. The combined model achieved an AUC of 0.77. Within the ACL subgroup, higher body fat % predicted poorer KOOS-QoL (β=−4.5, p=0.01), and better symmetry predicted less pain (β=+3.8, p=0.01). Sensitivity analyses confirmed these findings.

Conclusions: Excess adiposity and reduced limb symmetry were independently associated with ACL injury and worse functional outcomes in sports injury patients. Screening beyond BMI, focusing on body composition and muscular balance, may support targeted prevention and rehabilitation in orthopedic practice.

J Shaheed Suhrawardy Med Coll 2024; 16(1): 43-47