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. 2019 May 15;7(5):2325967119844265.
doi: 10.1177/2325967119844265. eCollection 2019 May.

Predictors of Pain and Function Before Knee Arthroscopy

Cleveland Clinic Sports Knee Group; Matthew C Bessette  1 , Robert W Westermann  1 , Alan Davis  1 , Lutul Farrow  1 , Mia S Hagen  1 , Anthony Miniaci  1 , Robert Nickodem  1 , Richard Parker  1 , James Rosneck  1 , Paul Saluan  1 , Kurt P Spindler  1 , Kim Stearns  1 , Morgan H Jones  1
Affiliations

Predictors of Pain and Function Before Knee Arthroscopy

Cleveland Clinic Sports Knee Group et al. Orthop J Sports Med. .

Abstract

Background: Patient-reported outcome measures are commonly used to measure knee pain and functional impairment. When structural abnormality is identified on examination and imaging, arthroscopic partial meniscectomy and chondroplasty are commonly indicated for treatment in the setting of pain and decreased function.

Purpose: To evaluate the relationship between patient characteristics, mental health, intraoperative findings, and patient-reported outcome measures at the time of knee arthroscopy.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Between February 2015 and October 2016, patients aged 40 years and older who were undergoing routine knee arthroscopy for meniscal and cartilage abnormality, without reconstructive or restorative procedures, were prospectively enrolled in this study. Routine demographic information was collected, and the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, Quality of Life (QoL), and Physical Function Short Form (PS) subscales and the mental and physical component subscales of the Veterans RAND 12-Item Health Survey (VR-12 MCS and VR-12 PCS) were administered preoperatively on the day of surgery. Intraoperative findings were collected in a standardized format. Patient demographics, intraoperative findings, and the VR-12 MCS were used as predictor values, and a multivariate analysis was conducted to assess for relationships with the KOOS and VR-12 as dependent variables.

Results: Of 661 eligible patients, baseline patient-reported outcomes and surgical data were used for 638 patients (97%). Lower scores on both subscales of the VR-12 were predicted by female sex, positive smoking history, fewer years of education, and higher body mass index (BMI). All KOOS subscales were negatively affected by lower VR-12 MCS scores, female sex, lower education level, and higher BMI in a statistically meaningful way. Positive smoking history was associated with worse scores on the KOOS-PS. Abnormal synovial status was associated with worse KOOS-Pain.

Conclusion: The demographic factors of sex, smoking status, BMI, and education level had an overwhelming impact on preoperative KOOS and VR-12 scores. Of interest, mental health as assessed by the VR-12 MCS was also a consistent predictor of KOOS scores. The only intraoperative finding with a significant association was abnormal synovial status and its effect on KOOS-Pain scores.

Keywords: knee arthroscopy; knee function; knee pain; patient-reported outcome measures.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Research reported in this publication was partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award No. R01 AR053684 (to K.P.S.) and under award No. K23 AR066133, which supported a portion of M.H.J.’s professional effort. The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institutes of Health. M.C.B. has received educational support from Arthrex and Smith & Nephew and hospitality payments from Arthrex, DePuy Synthes, and Zimmer Biomet. R.W.W. has received educational support from Arthrex and Smith & Nephew and hospitality payments from Arthrex and Medical Device Business Solutions. A.D. has received educational support from Arthrex and Rock Medical and hospitality payments from Amniox, Arthrex, Conventus, Trice Medical, and Wright Medical. L.F. has received consulting fees from Zimmer Biomet and hospitality payments from the Musculoskeletal Transplant Foundation. M.S.H. has received educational support from Arthrex and Smith & Nephew and hospitality payments from Medical Device Business Solutions. A.M. has received consulting fees from Amniox Medical, Arthrosurface, Linvatec, and Stryker; speaking fees from Trice Medical; educational support from Rock Medical; and hospitality payments from Arthrex, DJO, and Smith & Nephew; receives royalties from Arthrosurface, Wolters Kluwer, and Zimmer Biomet; and has stock or stock options in Arthrosurface and Trice Medical. R.P. receives royalties from Zimmer Biomet and has received hospitality payments from the Musculoskeletal Transplant Foundation and Smith & Nephew. J.R. has received educational consulting fees from Smith & Nephew. P.S. has received consulting fees from Arthrex, educational support from Rock Medical, and hospitality payments from DJO, Medical Device Business Solutions, and the Musculoskeletal Transplant Foundation. K.P.S. has received research support from DonJoy and Smith & Nephew and hospitality payments from DePuy; receives royalties or consulting fees from the NFL, Cytori, and Mitek; and receives royalties from nPhase. K.S. has received honoraria from Fidia Pharma, educational support from Arthrex and Biomet, and hospitality payments from Horizon Pharma, MTS, Ramsay Medical, and Stryker. M.H.J. is a member of the Scientific Advisory Board for Samumed. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Effect of each predictor on Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS), with the other predictors held constant. BMI, body mass index.
Figure 2.
Figure 2.
Effect of each predictor on Veterans RAND 12-Item Health Survey Physical Component Score (VR-12 PCS), with the other predictors held constant. BMI, body mass index.
Figure 3.
Figure 3.
Effect of each predictor on Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, with the other predictors held constant. BMI, body mass index; VR-12 MCS, Veterans RAND 12-Item Health Survey Mental Component Score.
Figure 4.
Figure 4.
Effect of each predictor on Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), with the other predictors held constant. BMI, body mass index; IQR, interquartile range; VR-12 MCS, Veterans RAND 12-Item Health Survey Mental Component Score.
Figure 5.
Figure 5.
Effect of each predictor on Knee injury and Osteoarthritis Outcome Score Quality of Life (KOOS-QoL), with the other predictors held constant. BMI, body mass index; IQR, interquartile range; VR-12 MCS, Veterans RAND 12-Item Health Survey Mental Component Score.
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