Timing of anterior cruciate ligament reconstruction and preoperative pain are important predictors for postoperative kinesiophobia

Abstract

Purpose Fear of movement (kinesiophobia) is a major limiting factor in the return to pre-injury sport level after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to gain insight into the prevalence of kinesiophobia pre-ACLR, 3 months post-ACLR and 12 months post-ACLR. Furthermore, the preoperative predictability of kinesiophobia at 3 months post-ACLR was addressed. Methods A retrospective study with data, which were prospectively collected as part of standard care, was conducted to evaluate patients who underwent ACLR between January 2017 and December 2018 in an orthopaedic outpatient clinic. Patient characteristics (age, sex, body mass index), injury-to-surgery time, preoperative pain level (KOOS pain subscale) and preoperative knee function (IKDC-2000) were used as potential predictor variables for kinesiophobia (TSK-17) at 3 months post-ACLR in linear regression analysis. Results The number of patients with a high level of kinesiophobia (TSK > 37) reduced from 92 patients (69.2%) preoperatively to 44 patients (43.1%) 3 months postoperatively and 36 patients (30.8%) 12 months postoperatively. The prediction model, based on a multivariable regression analysis, showed a positive correlation between four predictor variables (prolonged injury-to-surgery time, high preoperative pain level, male sex and low body mass index) and a high level of kinesiophobia at 3 months postoperatively (R 2 = 0.384, p = 0.02). Conclusion The prevalence of kinesiophobia decreases during postoperative rehabilitation, but high kinesiophobia is still present in a large portion of the patients after ACLR. Timing of reconstruction seems to be the strongest predictor for high kinesiophobia 3 months post-ACLR. This study is the first step in the development of a screening tool to detect patients with kinesiophobia after ACLR. Identifying patients preoperatively opens the possibility to treat patients and thereby potentially increase the return to pre-injury sport level rate after ACLR. Level of evidence III.

Kinesiophobia Levels in Patients with Parkinson’s Disease: A Case-Control Investigation

“…Kinesiophobia prevalence data varies according to what population group is being assessed. For example, it is found in 62% of patients after the reconstruction of the anterior cruciate ligament in the knee, 66.6% of patients with lupus erythematosus, and 75.1% of patients with fibromyalgia [ 6 , 7 , 8 ].…”

Impact of tourniquet during knee arthroplasty: a bayesian network meta-analysis of peri-operative outcomes

“…Similar results were reported by Zhang et al [ 3 ] in 2017 from eight studies comparing incision-to-suture versus a full-time tourniquet regime. Likewise, in 2019, Liu et al [ 84 ] analysed operating times across several tourniquet protocols, evidencing significantly longer surgeries in the absence group compared to the full-time tourniquet group ( P = 0.005). On the other hand, Wang et al [ 12 ] found no difference in surgical duration between shorter tourniquet use during cementation only and longer tourniquet use across 338 procedures; however, their findings were compromised by a high level of heterogeneity across the data.…”

“…In 2018, Wang et al [ 12 ] performed a meta-analysis comparing cementation only versus longer tourniquet use, and found significantly less intraoperative blood loss with long-term tourniquet use. Intraoperative blood loss was also analysed by Liu et al, in 2019, [ 84 ], who found that full-time tourniquet use was correlated with lower intraoperative blood loss compared to absence (1011 samples, P < 0.0001) and cementation only groups (323 samples, P < 0.0001). Previous meta-analyses have reported similar findings [ 85 , 86 ].…”

“…Wang et al [ 12 ] found statistically significant lower total blood loss with long-term tourniquet use compared to the cementation group. Liu et al [ 84 ] found no statistically significant differences concerning total estimated blood loss by comparing absence versus full-time and incision-to-suture versus full-time tourniquet use. Tie et al [ 11 ] found lower blood loss in the late tourniquet release compared to early release across approximately thousand patients; this result was statistically significant, but a high level of heterogeneity was also detected.…”

“…Wang et al [ 12 ] found no difference between the cementation and long-term tourniquet ( P = 1) across 167 procedures. The 2019 meta-analysis by Liu et al [ 84 ] found no statistical difference concerning transfusion rates. However, shorter tourniquet time resulted in a higher rate of transfusion (23.5%) compared with incision-to-suture (17.7%) and full-time tourniquet (20.4%).…”