Abstract
Objectives:
Osteochondritis dissecans of the knee is a challenging condition for young patients and their families. It often requires surgical treatment or months of nonsurgical treatment, with unpredictable healing rates and timing of return to sport. Little is known about the psychological effects this condition, and its treatment, have on young patients. The purpose of this study was to examine the psychological effects of knee OCD diagnosis and treatment recommendations on young patients. We hypothesize that diagnosis and treatment recommendations for knee OCD will be associated with increased levels of psychological stress, anxiety, depression, and symptoms of post-traumatic stress disorder in adolescent patients.
Methods:
Patients aged 11-19 years were prospectively enrolled at the time of knee OCD diagnosis/consultation for definitive treatment at two large pediatric orthopaedic sports medicine centers, with one of 5 surgeons. Patient’s completed patient reported outcomes (PROs) at enrollment after diagnosis and treatment recommendations were given, which included Children’s Revised Impact of Events (CRIES), in which a value of > 30 is indicative of post-traumatic stress disorder (PTSD) symptoms, PROMIS-Psychological Stress Experiences (PSE), PROMIS Depression, PROMIS Anxiety, IKDC, KOOS, and Pedi-FABS. PROs at enrollment were summarized and compared across sex, and PROMIS measures were compared to a general population mean of 50.
Results:
Amongst 126 participants (median age=13 years; 68% male), the median CRIES score was 15 with higher scores noted in females (median 20 versus 13 in males, p=0.03). 15% of patients scored >30 on the CRIES measure. These patients with >30 on the CRIES measure also had significantly worse PROMIS-PSE (62 vs 50; p<0.001), PROMIS Depression (59 vs 45; p<0.001), PROMIS Anxiety (59 vs 46; p<0.001) and IKDC (43 vs 62; p=0.001) scores compared to the rest of the cohort.
The median PROMIS-PSE score for the cohort was 53. Females had a higher median psychological stress score than males (55 vs 50; p=0.01) and the population mean (p=0.008). The median PROMIS Anxiety score for the cohort was 47 (p=0.94). Female anxiety scores (median=53) were higher than males (median=46; p<0.001). Median male anxiety scores were significantly lower than the population mean (p=0.04). The median PROMIS Depression score for the cohort was 47 (p=0.11). Males had a significantly lower depression score (median=44) compared to the general population (p=0.006). These sex related differences in PROs are demonstrated in Figure 1 and Table 1.
No significant differences were detected across sex in KOOS, IKDC, or Pedi-FABS scores at enrollment.
Conclusions:
The psychological impact of diagnosis and treatment recommendations associated with knee OCD varies amongst adolescents. 15% of young patients reported PTSD symptoms after receiving diagnosis and treatment recommendations for OCD of the knee. Females report greater stress, anxiety, and PTSD symptoms than males when diagnosed with OCD of the knee.
Follow up data from this study and future studies will help delineate if baseline psychological factors can serve as potential predictors of differences in treatment outcomes. A future aim of this prospective study is to examine how these outcome measures change over time. The results of this study may also be used to guide interventions that address the psychological effects of knee OCD diagnosis and treatment recommendations on specific populations.
