Background

Psychological factors influence knee surgery outcomes, but it is unclear whether athlete status, chronic symptoms, or prior knee surgery influences pre-operative psychological status.

Purpose

To determine whether pre-operative psychological status before outpatient knee surgery is influenced by athletic status, symptom chronicity, or prior surgical history.

Methods

495 knee surgery patients (247 athletes, 250 non-athletes) completed a pre-operative electronic survey. All patients were age 14 and over and had knee pathology requiring surgical treatment. International Knee Documentation Committee subjective scores (IKDC-S), Tegner Activity scores, and Marx activity scores were collected. Psychological and pain surveys included the McGill pain scale, Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS), New General Self-Efficacy Scale (NSES), and Life Orientation Test-Revised (LOT-R) for optimism. Multivariable conditional linear regression was used to determine the independent effects of athlete status, symptom chronicity (>6 months or =6 months), and history of prior surgery on pre-operative self-reported knee function, pain and psychological status after matching for age, sex, and surgical procedure.

Results

Athletes were younger than non-athletes on average (mean 27.7 years, SD 11.4 versus 41.6 years, SD 13.5; p < 0.001). The most frequently reported level of play among athletes was intramural or recreational (n=110, 44.5%). Among athletes, the most common reported sport participation was basketball (22.7%, n=56). Athletes had higher pre-operative IKDC-S scores (mean 2.5 points higher, SE 1.0; p= 0.015) and lower McGill Pain scores compared to non-athletes (mean 2.0 points lower, SE 0.85; p= 0.017). After matching for age, sex, athlete status, prior surgery, and procedure type, having chronic symptoms resulted in higher pre-operative IKDC-S (p< 0.001), pain catastrophizing (p< 0.001) and kinesiophobia scores (p= 0.044).

Conclusion

Athletes tended to have slightly better symptom/pain and function scores pre-operatively than non-athletes of similar age, sex, and knee pathology, but no difference in multiple psychological distress outcomes measures. Patients with chronic symptoms tend to have more pain catastrophizing and kinesiophobia, while those who have had prior knee surgeries have slightly higher pre-operative McGill pain score.