P229 - Predictors of poor pre-operative psychological status in cartilage defect patients
To determine prevalence and risk factors for excessive depressive symptoms, pain catastrophizing, and kinesiophobia in high grade cartilage defect patients.
Methods and Materials
A total of 222 patients (mean age 34.1 SD 13.7; 52% male) with high-grade cartilage defects (56% chondroplasty, 36% microfracture, 22% autologous chondrocyte implantation) completed a preoperative survey including IKDC-S score, Tegner activity score, Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK-11), and Patient Health Questionnaire depression scale (PHQ-9). Factors predictive of excessive depressive symptoms, pain catastrophizing and kinesiophobia were determined via multivariate logistic regression. Potential predictors assessed were age, sex, activity level, symptom duration, number of prior knee surgeries, planned surgical procedure, and IKDC-S score.
The mean pre-injury Tegner score was 5.8 (SD 2.4) and IKDS-S score was 44.7 (SD 11.1): 59% had no prior surgeries, 25% 1 prior surgery, and 16% 2+ prior surgeries. The average decrease in Tegner scores following symptom onset was 3.1 points. Prior to surgery, 25% had abnormal pain catastrophizing (PCS≥30 points), 14.4% had moderate-severe depression (PHQ ≥10), and 49.0% had high kinesiophobia (TSK-11 ≥25). A lower pre-operative Tegner score was predictive of moderate-severe depressive symptoms (per point decrease, Odds Ratio 1.36, 95% CI 1.06, 1.76; p=0.008). Predictors of excessive pain catastrophizing were lower pre-operative IKDC-S scores (per 5 point decrease, OR 1.28 CI 1.08, 1.51; p =0.002) and symptom duration >6 months (OR 2.20 CI 1.14, 4.32; p=0.02). The only predictor of excessive kinesiophobia was worse pre-operative IKDC-S scores (per 5 point decrease, OR 1.17 CI 1.03, 1.33; p=0.02).
Poor self-reported knee function, low activity levels, and symptom duration >6 months are risk factors for suboptimal psychological status prior to surgery in high grade cartilage defect patients. Age, sex, number of prior surgeries, and planned surgical procedure did not influence psychological readiness for surgery.