Summary

Individual psychological characteristics and personality structures have a significant influence on the functional outcome and the psychological readiness to return to sport after MPFL reconstruction.

Abstract

Purpose

To evaluate the influence of patient-specific psychological characteristics and personality structures on the functional outcome and return to sports after isolated medial patellofemoral ligament (MPFL) reconstruction.

Methods

All patients who underwent isolated MPFL reconstruction between 2017 and 2020 were retrospectively included. Minimum 18 months postoperatively, patient-reported outcome measures, including the BANFF Patellofemoral Instability Instrument 2.0 (BPII 2.0), Visual Analog Scale (VAS) for pain and function, Tegner Activity Scale (TAS) and Marx Activity Rating Scale (MARS) were evaluated. The MPFL-Return to Sport after Injury (MPFL-RSI) scale was used to determine psychological readiness to return to sport. Kinesiophobia was measured using the Tampa Scale of Kinesiophobia (TSK) and the tendency to catastrophize pain was measured using the Pain Catastrophizing Scale (PCS). Self-efficacy was assessed using the General Self-Efficacy Short Scale-3 (GSE-3 scale). Personality structure was classified using a variant of the Big Five Inventory (BFI-10). The Live Orientation Test (LOT-R) was used to measure generalized optimism and pessimism. The data was statistically analyzed as appropriate using Pearson or Spearman correlation analysis.

Results

In total, 54 patients (24 ± 8 years, follow-up: 35,8 ± 12,8 months) were included. MPFL-RSI and BPII 2.0 correlated inversely with VAS for pain (r = -0.58, and r = -0.63, p < 0.001) and function (r = -0.44 and r = -0.62, p < 0.001), fear of movement (TSK; r= -0.4.71, p < 0.001; r = -0.525, p < 0.001) and pain catastrophizing (PCS; r = -0.375, p = 0.006; r = -0.485, p < 0.001). Both the MPFL-RSI and BPII 2.0 correlated significantly with self-efficacy (GSE-3; r = 0.41, p = 0.003 and r = 0.39, p = 0.004) as well as with each other (r = 0.85, p = < 0.001). The MPFL-RSI correlated inversely with the personality chracteristic "neuroticism" (BFI-10; r = -0.328, p = 0.018) and positively with sporting activity (MARS; r = 0.318, p = 0.020).

Conclusion

Individual psychological characteristics and personality structures have a significant influence on the functional outcome and the psychological readiness to return to sport after MPFL reconstruction. Increased self-efficacy, reduced pain catastrophizing and exercise phobia are associated with better postoperative knee function. Preoperative assessment and consideration of these factors could serve as a basis for patient-specific therapy and rehabilitation and ultimately improve outcomes.