Investigating the Impact of Preoperative Kinesiophobia and Pain on Postoperative Gait Biomechanics Following Anterior Cruciate Ligament Injury.

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-02-19 eCollection Date: 2025-02-01 DOI:10.1177/23259671241301376
Caroline Lisee, Shelby Baez, Elizabeth Bjornsen, Louise Thoma, Troy Blackburn, Jeffrey T Spang, R Alexander Creighton, Ganesh Kamath, Jessica Hu, Brian Pietrosimone
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引用次数: 0

Abstract

Background: Aberrant gait biomechanics-ie, lower knee abduction moment (KAM) impulse- are linked to the development of posttraumatic osteoarthritis after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). There is a clinical need to identify modifiable factors, such as kinesiophobia and pain, that may contribute to aberrant gait development after ACLR to advance multimodal rehabilitation strategies.

Purpose/hypothesis: This study aimed to determine associations between preoperative kinesiophobia and pain and gait biomechanics linked to posttraumatic osteoarthritis development at 2 and 4 months after ACLR. We hypothesized that worse preoperative kinesiophobia and pain would be associated with lower KAM impulses in the ACLR limb but not the uninjured limb at 2 and 4 months after ACLR.

Study design: Cohort study; Level of evidence, 2.

Methods: Patients within 6 weeks of ACL injury and planning to undergo ACLR with bone-patellar tendon-bone autografts were recruited for the study. Preoperatively, participants completed the Tampa Scale of Kinesiophobia (TSK-11) and Knee injury and Osteoarthritis Outcome Score Pain (KOOS Pain) subscale surveys to assess kinesiophobia (ie, psychological component to pain) and knee pain, respectively. Participants returned at 2 and 4 months after ACLR to complete a 3-dimensional gait biomechanics analysis. KAM impulses during the stance phase were calculated (N*m*s/N*m) for both limbs. Associations of preoperative TSK-11 and KOOS Pain scores with KAM impulses in ACLR and uninjured limbs were analyzed using separate linear regressions.

Results: A total of 36 participants (58% women; mean age, 21.4 ± 4.31 years; body mass index, 24.1 ± 3.59 kg/m2 ) completed 3 study visits. Higher preoperative kinesiophobia was associated with lower KAM impulses in the ACLR limb (R 2 = 0.14; P = .02) but not the uninjured limb (R 2 = 0.01; P = .58) at 4 months after ACLR. Preoperative KOOS Pain scores were not associated with KAM impulses in the ACLR and uninjured limbs at 2 and 4 months after ACLR (ΔR 2 range, <0.01-0.02; P range = .53-.90).

Conclusion: Preoperative kinesiophobia, but not pain, was weakly associated with lower KAM impulses during early to midphases of clinical recovery at 4 months after ACLR.

研究术前运动恐惧症和疼痛对前交叉韧带损伤术后步态生物力学的影响。
背景:异常的步态生物力学-即,下膝外展力矩(KAM)冲动-与前交叉韧带(ACL)损伤和ACL重建(ACLR)后创伤后骨关节炎的发展有关。临床需要确定可改变的因素,如运动恐惧症和疼痛,这些因素可能导致ACLR后异常步态的发展,以推进多模式康复策略。目的/假设:本研究旨在确定ACLR术后2个月和4个月与创伤后骨关节炎发展相关的术前运动恐惧症、疼痛和步态生物力学之间的关系。我们假设,在ACLR术后2个月和4个月,术前更严重的运动恐惧症和疼痛与ACLR肢体较低的KAM脉冲有关,而与未损伤肢体无关。研究设计:队列研究;证据等级2。方法:研究对象为前交叉韧带损伤6周内计划行自体骨-髌腱-骨移植ACLR的患者。术前,参与者完成坦帕运动恐惧症量表(TSK-11)和膝关节损伤和骨关节炎结局评分疼痛(oos疼痛)亚量表调查,分别评估运动恐惧症(即疼痛的心理成分)和膝关节疼痛。参与者在ACLR术后2个月和4个月返回完成三维步态生物力学分析。计算四肢站立阶段的KAM脉冲(N*m*s/N*m)。术前TSK-11和kos疼痛评分与ACLR和未损伤肢体的KAM脉冲的关系采用单独的线性回归分析。结果:共有36名参与者(58%为女性;平均年龄21.4±4.31岁;身体质量指数(24.1±3.59 kg/m2)完成了3次研究访问。术前较高的运动恐惧症与ACLR肢体较低的KAM脉冲相关(r2 = 0.14;P = 0.02),未损伤肢体无明显差异(r2 = 0.01;P = .58)。术前KOOS疼痛评分与ACLR术后2个月和4个月时ACLR和未损伤肢体的KAM脉冲无关(ΔR 2范围,P范围= 0.53 - 0.90)。结论:在ACLR术后4个月临床恢复的早期到中期,术前运动恐惧症与较低的KAM脉冲呈弱相关,但与疼痛无关。
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来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
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