Background

Cartilage injuries of the knee affect a large number of people in United States annually, and many of these patients undergo surgical intervention. Identifying factors predictive of the psychological status of surgical patients may be advantageous in determining which patients will benefit from additional screening and potentially intervention. To evaluate the risk factors for pain catastrophizing, kinesiophobia, and elevated depressive symptoms among patients undergoing high-grade cartilage defect surgery. We hypothesized that cartilage patients would demonstrate high scores on pain catastrophizing, kinesiophobia, and depression testing prior to surgery. Methods: Two hundred and ten patients undergoing surgery for high-grade cartilage defects (56% chondroplasty, 36% microfracture, 22% autologous chondrocyte implantation) completed a preoperative survey before undergoing surgery. Outcome scores assessed were IKDC-S score, Tegner activity score, Pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK-11), and Patient Health Questionnaire depression scale (PHQ-9). Multivariate logistic regression was used to determine what pre-operative factors predicted pain catastrophizing, kinesiophobia, and elevated depressive symptoms.

Results

The mean pre-operative Tegner score was 5.8 (SD 2.4) and IKDS-S score was 44.7 (SD 11.1). Prior to surgery, 19% had abnormal pain catastrophizing (PCS = 20 points), 14.4% had moderate-severe depression (PHQ = 10), and 49.0% had high kinesiophobia (TSK-11 = 25). Lower pre-operative Tegner scores predicted moderate-severe depressive symptoms (per point decrease, OR 1.36, 95% CI 1.06, 1.76; p= 0.008). Predictors of elevated pain catastrophizing were lower pre-operative IKDC-S scores (per 5-point decrease, OR 1.28 , 95% CI 1.08, 1.51; p= 0.002) and symptom duration >6 months (OR 2.20 CI 1.14, 4.32; p= 0.02). A lower pre-operative IKDC-S score (per 5-point decrease, OR 1.17, CI 1.03, 1.33; p= 0.02) predicted elevated kinesiophobia.

Conclusion

Low self-reported function, low activity level and symptom duration greater than six months are associated with poor preoperative psychological status. The relatively high prevalence of pain catastrophizing, kinesiophobia, and depressive symptoms warrants consideration of preoperative psychological screening in patients undergoing high-grade cartilage defect (ICRS Type III or IV) repair.