Patients who have recurrent kneecap dislocations experience more fear of movement and pain catastrophizing compared to other knee conditions
Recurrent kneecap dislocations, also known as patellar instability (PI), occur when the kneecap repeatedly slides out of the groove in the front of the knee.
This condition is a common and disabling knee condition that more frequently affects adolescents.
— Learn more about patellar instability (PI) here —
Research studies have shown that recovery from injury, or from surgery that stabilizes the kneecap, involves not only physical factors, but also emotional and psychological aspects.
Patient questionnaires, also known as Patient-Reported Outcome Measures (PROMs), can measure these aspects. PROMs are important because they give healthcare providers valuable insights into how treatments impact a patient’s daily life, well-being, and overall health.
One important PROM developed and used by the orthopaedic surgeons at Banff Sport Medicine to assess patients with PI is the Banff Patellofemoral Instability Instrument, or BPII.
Dr. Laurie Hiemstra recently led a research study using the BPII that found patients with recurrent PI had more fear of movement, known as kinesiophobia, as well as more pain catastrophizing than patients with other knee injuries.
In this study, the research team assessed patients using the BPII questionnaire and other PROMs, such as the Tampa Scale for Kinesiophobia (TSK-11) and the Pain Catastrophizing Scale (PCS).
Kinesiophobia – fear of movement caused by underlying anxiety about reinjury.
Pain catastrophizing – the degree to which patients ascribe a higher level of worry, apprehension, and fear to the pain they feel and anticipate feeling.
Using these PROMs, they found that patients with PI reported higher levels of kinesiophobia and pain catastrophizing than patients with other knee injuries. For example, patients with PI had an average score of 29.7 / 44 on the TSK-11 compared to patients with an ACL-deficient knee, who scored an average of 20 / 44. A higher score indicates worse kinesiophobia.
— LISTEN to a podcast about this research study —
So, what does this mean for patients?
Other research studies have found that kinesiophobia and higher pain catastrophizing can significantly affect recovery after surgery.
If surgeons can use these PROMs to identify patients reporting higher levels of these emotional and psychological aspects, they can provide additional support to help optimize their recovery.
Because emotional and psychological aspects of injury recovery are not well understood, some next steps in this research will include figuring out the best supports for patients with kinesiophobia and pain catastrophizing and how they can be put into practice.
Hiemstra LA, Lafave MR, Bentrim A, Kerslake S. The Influence of Kinesiophobia and Pain Catastrophizing on Disease-Specific Quality of Life in Patients With Recurrent Patellofemoral Instability. The American Journal of Sports Medicine. 2024;0(0). doi:10.1177/03635465241281341
