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Mental Health Does Not Predict Outcomes After Osteochondral Allograft in the Knee

Key findings

  • Several prior studies across various orthopedic subspecialties have demonstrated an association between preoperative mental health and postoperative pain and function
  • In a retrospective review of prospectively collected data on 67 patients, the preoperative 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) had no predictive value for patient-reported outcomes
  • Neither was the 12-SF MCS associated with change in scores from baseline to final follow-up of at least 2 years
  • Still, given the discrepancy between these findings and previous studies, it is advisable to assess preoperative patient mental health to aid shared decision-making about the choice of cartilage repair procedure

Initially used as a salvage procedure after failed cartilage repair, osteochondral allograft (OCA) transplantation is now performed increasingly often as the primary procedure for large osteochondral defects in the knee, generally with excellent clinical results.

Several studies have reported that low preoperative mental health can contribute to poor outcomes of orthopedic surgery, but whether this was true of OCA transplantation in the knee had never been studied. Research Fellow Jakob Ackermann, MD, and colleagues report in the Orthopaedic Journal of Sports Medicine that using the 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) does not help predict pain and functional outcomes.

Even so, given the disparity between these findings and studies of other cartilage repair options, preoperative mental health should be considered when choosing the most appropriate treatment for osteochondral defects in the knee.

Study Design

The researchers reviewed the records of 67 patients who underwent OCA transplantation for focal osteochondral defects in the knee between March 2011 and April 2016.

Those assessments included the SF-12 MCS, the International Knee Documentation Committee questionnaire, the five subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS: pain, symptoms, activities of daily living, sport/recreation and quality of life), the Tegner activity scale and the Lysholm score.

Most patients were female (55%), the average age was 35 (range, 16–54) and the average length of follow-up was 2.7 years (range, 2–6 years). At baseline the average KOOS pain score was 81 and the average KOOS symptoms score was 54.

The number of grafts per patient ranged from one to four, with 46% of patients treated with two or more. The average combined size of all grafts per patient was 5.0 cm2. Twenty-four patients underwent concomitant osteotomy, two had concomitant meniscal allograft transplantation and one had concomitant medial patellofemoral ligament reconstruction. More than half of patients (57%) had undergone previous surgery on the same knee.

On multivariate analysis, the SF-12 MCS was not associated with a postoperative score on any of the self-assessed outcome measures, the researchers determined. Neither was it associated with the change in score on any measure from baseline to final follow-up.

Putting the Findings into Context

Several studies have shown that preoperative mental health significantly influences postoperative function in patients with cartilage defects who undergo autologous chondrocyte implantation (ACI), the researchers note. Separate research in orthopedics has shown that better mental health correlates with better adherence to rehabilitation.

The researchers speculate that their inability to find an effect of preoperative mental health on the results of OCA transplantation may relate to the relatively shorter time of recovery and easier rehabilitation after OCA, compared with ACI.

The findings also deviate from those of similar studies across orthopedic subspecialties. Therefore, the researchers recommend assessing mental health when considering OCA transplantation to treat cartilage injuries of the knee. The results can be important for preoperative counseling and choosing an appropriate treatment from among the different options for cartilage repair.

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