Summary

Adolescents can have significant psychological associations with OCD diagnosis/management, with 15% demonstrating post-traumatic stress disorder symptoms, and females reporting overall greater psychological symptoms compared to males.

Abstract

Background

Osteochondritis dissecans (OCD) of the knee is a challenging condition for young patients and their families; often requiring surgical treatment or months of nonsurgical treatment, with unpredictable healing rates and time to return to sport. The purpose of this study was to investigate psychological associations with knee OCD in adolescent patients. We hypothesized that diagnosis/treatment recommendations for knee OCD would be associated with increased levels of psychological stress, anxiety, depression, and symptoms of post-traumatic stress disorder in adolescent patients.

Methods

Adolescent patients (11-19 years) were prospectively enrolled at the time of knee OCD diagnosis/consultation for definitive treatment at two large pediatric orthopaedic sports medicine centers, with one of 5 surgeons. Patient reported outcomes (PROs) at enrollment included Children’s Revised Impact of Events (CRIES), in which a value of > 30 is indicative of post-traumatic stress disorder (PTSD) symptoms, PROMIS Psychological Stress Experiences (PSE), PROMIS Depression, PROMIS Anxiety, IKDC, KOOS, and Pedi-FABS. PROs at enrollment were summarized and compared across sex, and PROMIS measures were compared to a general population mean of 50.

Results

Amongst 126 participants (median age=13 years; 68% male), the median CRIES score was 15 with higher scores noted in females (median 20 versus 13 in males, p=0.03). 15% of patients scored >30 on the CRIES measure. These patients also had significantly worse PROMIS-PSE (62 vs 50; p<0.001), PROMIS Depression (59 vs 45; p<0.001), PROMIS Anxiety (59 vs 46; p<0.001) and IKDC (43 vs 62; p=0.001) scores compared to the rest of the cohort

Median PROMIS PSE score for the cohort was 53. Females had a higher median psychological stress score than males (55 vs 50; p=0.01) and the population mean (p=0.008). Median PROMIS Anxiety score for the cohort was 47 (p=0.94). Female anxiety scores (median=53) were higher than males (median=46; p<0.001). Median male anxiety scores were significantly lower than the population mean (p=0.04). Median PROMIS Depression score for the cohort was 47 (p=0.11). Males had a significantly lower depression score (median=44) compared to the general population (p=0.006).

No significant differences were detected across sex in KOOS, IKDC, or Pedi-FABS scores at enrollment.

Conclusions

The stress and anxiety from diagnosis/treatment recommendations associated with knee OCD varied amongst adolescents, but some patients demonstrated very significant symptoms. 15% of adolescents reported PTSD symptoms. Females reported more stress, anxiety, and PTSD symptoms than males when diagnosed with an OCD of the knee. Follow up data from this study and future studies will help delineate if baseline psychological factors can serve as potential predictors of treatment outcomes.