Background

It is unclear whether athlete status, chronic symptoms, or prior knee surgery influences pre-operative psychological status. The purpose of the present study was to determine whether pre-operative psychological status before outpatient knee surgery is influenced by athletic status 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. Multivariate 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 self-reported knee function, pain and psychological status after matching for age, sex, and knee condition. Matching was performed by age, sex and surgical procedure performed.

Results

Athletes were younger than non-athletes (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 scores (mean 2.5, SE 1.0; p= 0.015) and lower McGill Pain scores compared to non-athletes (mean 2.0, SE 0.85; p= 0.017). However, there were no differences between athletes compared to non-athletes when evaluating stress, depression, kinesiophobia, and pain catastrophizing.

Conclusion

Non-athletes and athletes alike, experienced similar levels of psychological stresses (stress, depression, kinesiophobia, and pain catastrophizing). This seems to imply that while athletes may have lower levels of functional impairment (IKDC) and pain pre-operatively, they have similar psychological distress compared to non-athletes. Thus, while athletes may be better equipped to handle surgery from a pain and function standpoint, their psyche may be in line more with non-athletes. In other words, an athletes’ strength may be in managing pain and maintaining function (physical component), but not necessarily in psychological distress (emotional component) coping.