Summary

Kinesiophobia, shoulder instability, arthroscopic Bankart repair, psychological factors, Tampa Scale

Abstract

Purpose

To estimate the association between postoperative kinesiophobia and some factors
significantly associated with the risk of recurrence in patients affected by recurrent anterior
glenohumeral instability (AGHI) and treated by arthroscopic Bankart repair (ABR). The
secondary purpose was to assess the correlation between objective and subjective outcomes of
ABR and kinesiophobia.

Methods

The study was designed as a retrospective observational study. The study population
consisted of patients affected by recurrent AGHI treated surgically through ABR with a
minimum time interval from surgical treatment of 24 months.
Kinesiophobia was assessed using the 13-item version of the Tampa Scale of Kinesiophobia
(TSK-13). The questionnaire is divided into two subscales: activity avoidance (AA), and health
anxiety (HA). The primary outcome of the study was the assessment of the association between
postoperative kinesiophobia and some potential predictors of outcome, such as age at surgery,
gender, dominance, generalized ligament laxity, age at onset of symptoms, timing from the first
dislocation to surgery, number of dislocations, type of sport, preinjury sports activity level,
bipolar bone defect assessed based on the Hill-Sachs interval to glenoid track width ratio (H/G
ratio), and duration of follow-up. Secondary outcomes were the correlations between
postoperative kinesiophobia and objective (recurrent instability) and the following patient-
reported outcomes (PROMs): ASES score, WOSI score, Tegner activity level scale, and the
Depression Anxiety Stress Scales-21 (DASS-21). Univariate and multiple linear regression
analyses were performed to find out significant association between kinesiophobia and outcome
predictors and between kinesiophobia and treatment outcomes. Significance was set for p<0.05.

Results

The study population consisted of 123 patients. The average overall TSK-13 score was
21.5 + 7.4. According to the grading of the TSK-13 score, kinesiophobia was subclinical in 77
cases (62.6%), mild in 25 cases (20.3%), moderate in 14 cases (11.4%), and severe in 7 cases
(5.7%). Multiple regression analysis showed a significant correlation between TSK-13 subscales
and overall score and dominance. Level of kinesiophobia was significantly associated with older
age at first dislocation, dominance, and no sports activity. Correlation with subjective and
functional outcomes was significant for all outcomes explored except for the DASS-21 score.
Conversely, kinesiophobia was not significantly correlated with the recurrence of instability.

Conclusions

Arm dominance, older age at first dislocation, and sedentary activity were
significant predictors of higher lever kinesiophobia after ABR. There was a significant
correlation between kinesiophobia and PROMs. Kinesiophobia was not significantly correlated
with recurrent instability.