Summary

Fear of reinjury and lack of confidence in the operative limb after surgery has been shown to influence patient satisfaction and return to sport rates. The purpose of this study is to evaluate the effect of kinesiophobia on satisfaction, return to sport rate, and clinical outcomes following osteochondral allograft (OCA) transplantation of the knee.

Abstract

Purpose

Fear of reinjury and lack of confidence in the operative limb after surgery has been shown to influence patient satisfaction and return to sport rates. The purpose of this study is to evaluate the effect of kinesiophobia on satisfaction, return to sport rate, and clinical outcomes following osteochondral allograft (OCA) transplantation of the knee.

Methods

Patients who underwent OCA transplantation at a single institution with at least 2 years of clinical follow-up were identified. Patient satisfaction was assessed using a 0-100 numeric scale, clinical outcomes were assessed using a visual analog scale (VAS) for pain, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) including sports, quality of life (QOL), symptoms, and pain subscales. Kinesiophobia was assessed using the validated Tampa Scale of Kinesiophobia, with higher scores indicating more fear of movement resulting in injury. Additionally, patients were asked to report whether they returned to sport at the same level, at a lower level, or did not return to their preferred sport following surgery. Variables were assessed for normality using Shapiro-Wilks test for normality. Continuous variables were compared using t-test or non-parametric tests. Categorical variables were compared using Chi-squared test. A one-way ANOVA was used to performed to compare satisfaction, clinical outcomes, and kinesiophobia levels among subjects based on return-to-sports status, using a post-hoc Tukey’s HSD test for multiple comparisons. Logistic regression controlling for age, sex, body mass index (BMI), follow-up, and VAS pain at the time of follow-up was used to determine if Tampa kinesiophobia score is predictive of return to sport after OCA transplantation.

Results

A total of 30 patients were reached for follow-up at an average of 44.5 ± 14.9 months. Of these, 11 (40%) did not return to sport, 10 (33.3%) returned to sport at their preoperative level or higher, and 9 (26.7%) returned to sport at a lower level. At follow-up there were no significant between group differences in VAS pain score (p=.444), KOOS-Symptom score (p=.749), or KOOS-Pain score (p=.093). There were significant differences between the groups in KOOS-Sport (p=.008), KOOS-QOL (p=.026), and Tampa Kinesiophobia Score (p=.019). Post-hoc Tukey’s test found that compared to those who did not return to sport, patients who returned at the same level had higher KOOS-Sport Subscore (83.14, p=.009), KOOS-QOL (71.9, p=.020) and lower Tampa Kinesiophobia scores (21.8, p=.031). On logistic regression controlling for age, sex, BMI, time to follow-up and VAS pain, increasing kinesiophobia was found to decrease the odds of returning to sports by almost half (OR [95% CI]; 0.59 [0.28-0.84], p=0.04).

Conclusion

This study found that despite similar pain levels and knee symptoms, patients who did not return to sport after OCA transplantation reported lower quality of life and KOOS-Sport subscores, as well as higher levels of pain-related fear of movement (kinesiophobia). After controlling for demographic factors and levels of pain, kinesiophobia remained a significant contributor to not returning to sport following an OCA procedure. Assessment of patient kinesiophobia by surgeons and physical therapists could identify patients at greater risk of not returning to preoperative sports activities.