Poster 267: Psychological Readiness and Return to Sport and Work Following Autologous Chondrocyte Implantation

OBJECTIVES: Return to preinjury function in work and sport is dependent on both postoperative physical function and psychological readiness. Kinesiophobia has been studied following various orthopedic surgeries, but data remains scant in patients undergoing cartilage restoration procedures. The purpose of our investigation is to evaluate the effect of fear of reinjury on return to sport (RTS), return to work (RTW), and clinical outcomes following autologous chondrocyte implantation. METHODS: A retrospective review of patients who underwent autologous chondrocyte implantation (ACI) and matrix-associated autologous chondrocyte implantation (MACI) at a single institution between 2012 – 2020 with a minimum of 2 year clinical follow-up was conducted. Patient-reported outcomes were measured using the Visual Analog Scale (VAS) for pain and satisfaction and the Knee Injury and Osteoarthritis Outcome Score (KOOS; subscores: symptoms, pain, sport, and quality of life (QOL)). Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11 (TSK-11). The Pain Catastrophizing Scale (PCS) was used to analyze individuals’ response to pain. T-tests or non-parametric tests and Chi-squared tests were used to analyze continuous variables and categorical variables, respectively. A one-way ANOVA was used to compare outcomes based on RTS status, using a post-hoc Tukey’s HSD test for multiple comparisons. Logistic regression controlling for age, sex, and BMI was used to determine if TSK-11 scores is predictive of RTS. RESULTS: Forty-nine patients, mainly male (55.1%) aged 29.35 (± 6.28) with a mean follow-up of 5.7 ± 3.2 years were included in our analysis. Sixteen patients (32.7%) did not RTS. Of the 33 patients (67.3%) who returned to sport, 16 (32.7%) returned at their preoperative level or higher, and 17 (34.7%) returned at a lower level. TSK-11 scores (26.44 vs. 20.62, p=0.019) and VAS pain scores (47.94 vs. 6.88, p<0.001) were significantly greater in patients that that did not return to sport compared to those who return at the same level or higher. All KOOS subscores (Symptom: 59.69 vs. 85.62, Pain: 71.35 vs. 94.97, Sports: 37.19 vs. 86.56, QOL: 29.69 vs. 82.42, p <0.001) were significantly lower in patients who did not RTS compared to those who returned at the same level or higher. Patients who returned to sport, but at a lower level, had significantly greater KOOS-QOL (58.82 vs. 29.69, p<0.001) and KOOS-pain subscores (89.22 vs. 71.35, p<0.001) compared to patients who did not RTS. There were no significant differences in PCS scores between all three groups (p = 0.08). Increasing TSK-11 scores were inversely related to probability of RTS (OR [95% CI]; -0.19 [0.36 to 0.06], p=0.01). Of the 40 (81.6%) patients employed prior to injury, 100% (n=40) returned to work. Thirty-six (90%) patients returned to modified work within six months of surgery and had significantly lower TSK-11 scores (23.00 vs. 30.50, p=0.01) compared to patients who returned to work >6 months postoperatively. CONCLUSIONS: Fear of reinjury decreases the likelihood that patients will return to preinjury level of sport or higher after autologous chondrocyte implantation. Those who did not return to work had significantly worse KOOS scores.