High Kinesiophobia and Pain Catastrophizing in People with Articular Cartilage Defects in the Knee
Authors: Thoma Louise M. , Flanigan David C. , Best Thomas M. , Schmitt Laura 
Published: July 2017

Objectives: Psychosocial factors, including kinesiophobia and pain catastrophizing, are increasingly recognized for the role they play in knee function and quality of life for people with anterior cruciate ligament reconstruction (ACLR), knee osteoarthritis (OA), and total knee arthroplasties (TKA). People with articular cartilage defects in the knee have impaired function and poor quality of life, however the extent to which they present with kinesiophobia and pain catastrophizing is not known. The purpose of this study is to compare kinesiophobia, i.e. fear of movement-related pain/reinjury, and pain catastrophizing of people with articular cartilage defects (ACD) in the knee to healthy controls. Methods: Thirty-five individuals (19M:16F, Age mean ± 95%CI 29.8 ± 2.8 years old, BMI 28.1 ± 1.44) seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls (9M:9F, Age 29.8 ± 3.0 years old, BMI 24.9 ± 1.3) without history of knee injury participated in the study. Exclusion criteria included; age >55 years, BMI >35kg/m2, recent surgery, current low back pain or unrelated lower extremity pain, and history of spine surgery or neurological injury and pathology. Kinesiophobia for all 53 subjects was measured with the Tampa Scale of Kinesiophobia (TSK). The TSK was scored using the original 17-item (TSK-17, Min 17 - Max 68) and modified 11-item (TSK-11, Min 11 - Max 44) scoring systems as both have been commonly used in the literature. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS, Min 0 - Max 52). Higher scores on these measures indicate greater kinesiophobia and pain catastrophizing. Independent t-tests were used to compare the ACD group to the healthy controls (α=0.05). Mean TSK and PCS scores (± 95% CI) were plotted alongside values published in samples with other knee pathologies for reference. Results: Participants with ACDs reported higher kinesiophobia (TSK-17 mean score ± 95%CI [range]: ACD 40.9 ± 1.7 [29-53], Healthy Control 29.9 ± 1.3 [26-35], p<0.001; TSK-11 score: ACD 27.0 ± 1.2[16-34], Healthy Control 15.8 ± 1.2 [11-20], p<0.001) and higher pain catastrophizing (PCS score: ACD 12.7 ± 3.5 [0-42], Healthy Control 4.0 ± 2.6 [0-14], p<0.001) than age-matched healthy controls. Greater kinesiophobia and pain catastrophizing were also observed in people with ACDs compared to values published in people after ACLR, people with knee OA, and similar to people with severe OA preparing for TKA (Figure 1). Conclusion: This is the first study to our knowledge to evaluate psychosocial factors in people with ACDs of the knee. Kinesiophobia and pain catastrophizing in people with knee ACDs were similar to people with severe knee OA preparing for TKA, and higher than healthy controls and people before and after ACLR. While higher kinesiophobia and pain catastrophizing are consistently associated with worse function and quality of life in these populations, understanding the relationship to outcomes and prognosis in people with knee ACDs remains unknown and is a target of our ongoing work.