Joint Preservation Hospital for Special Surgery Weill Cornell Medical School

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1 Hospital for Special Surgery Weill Cornell Medical School Mental Health Has No Predictive Association with Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation in the Knee Jakob Ackermann, MD, Takahiro Ogura, MD, Robert A. Duerr, MD, Alexandre Barbieri Mestriner, MD, Andreas H. Gomoll, MD 535 East 70 th Street New York, NY T:

2 Disclosure Jakob Ackermann, MD I received research support from Vericel and JRF Ortho No financial support for this project

3 Introduction Osteochondral allograft transplantation (OCA) Increasingly performed as a primary procedure for large osteochondral defects showing excellent clinical outcomes 1,2,3 Multiple factors influence postoperative outcome Influence of psychosocial factors to predict outcomes is of increasing interest Low patient mental health/depression was found to be associated with poor outcomes in: Trauma surgery 4, 8 Spine surgery 5, 10, 11, 12 Hand and upper extremity surgery 6, 7, 9 Osteoarthritis 13, 14, 15 ACL reconstruction and total knee arthroplasty 16, 17, 18

4 Purpose Introduction To determine the role of psychological factors on patient-reported pain and functional outcomes in patients after OCA Hypothesis Poor preoperative mental health, as measured with the Short Form-12 Mental Component Summary (SF-12 MCS), is associated with diminished scores at minimum follow up of 24 months

5 Materials and Method Patient Selection OCA for focal osteochondral defects in the knee Single surgeon March 2011 to April 2016 Minimum 2-year follow-up PROMs Patient Factor Lesion Factor SF-12 MCS Age Size BMI Number Lysholm Sex Location Tegner Smoking status IKDC WC status Previous surgeries Concomitant surgeries

6 Results Patient Characteristics, Postoperative Outcome and Improvement Scores Patients n = 67 Age, y, mean ± SD 35.0 ± 10.0 BMI, kg/m 2, mean ± SD 26.8 ± 4.7 Female Gender, n 37 Mean Follow-up, mean ± SD 2.7 ± 1.0 Smokers, n 5 WC, n 2 Concomitant HTO, n 12 Concomitant TTO, n 11 Concomitant DFO, n 1 Concomitant MAT, n 2 Concomitant MPFL, n 1 Previous Surgery, n 38 OCA Size, cm 2, mean ± SD 5.0 ± 3.7 Number of Plugs, mean ± SD 1.6 ± 0.7 Plug Location MFC, n 40 LFC, n 21 Trochlea, n 12 Patella, n 8 PROM Total Score (Mean ± SD) Delta Score (Mean ± SD) Pain ± ± Symptoms 54.0 ± ± ADL ± ± Sport/Recreation ± ± QOL ± ± Tegner 4.1± ± 2.65 Lysholm 75.1 ± ± IKDC ± ± SF-12 MCS ± ± 8.53

7 Results Uni- and Multivariable Regression Models Despite significant bivariate correlations, the SF-12 MCS had no predictive association with any PROM in the multivariable linear regression models. The SF-12 MCS showed no bivariate correlation with any PROM Delta (P >.05). Patient sex contributed significantly to the final regression models of: Sport/Recreation (P =.042) Tegner (P =.024) Lysholm (P =.031) Univariable Regression of Preoperative SF-12 MCS and Postoperative Patientreported Outcome Measures at Final Follow-Up Pain Symptoms ADL Sport/ Recreation QOL Tegner Lysholm IKDC Pearson P Univariable Regression of Preoperative SF-12 MCS and Improvement (Delta) of Patient-reported Outcome Measures at Final Follow-Up Pain Symptoms ADL Sport/ Recreation QOL Tegner Lysholm IKDC Pearson P

8 Discussion Preoperative mental health assessment may provide useful prognostic information in patients with osteoarthritis undergoing arthroplasty 19, 20 Preoperative mental health has significant influence on postoperative functional scores after ACI 21,22 Shorter recovery time and easier rehab in patients after OCA than ACI may explain the disparity in results Compliance with rehabilitation and a patient s mental health are likely related 23 ACI may require better preoperative mental health than OCA in order to attain good compliance with the longer and more involved postoperative course to achieve better postoperative function

9 Limitations Retrospective review of prospectively collected data Small study group Represented only 50% of the eligible population But study population was representative for the entire eligible population As a tertiary referral center for cartilage repair, patients in this study had relatively large or multiple cartilage defects

10 Conclusion Preoperative mental health demonstrated no predictive value for postoperative PROMs Female sex was negatively correlated with Sport/Recreation Tegner Lysholm scores Given the disparity between our findings and previous reports on other cartilage repair options, it is advisable to include preoperative mental health as one of the many factors involved in the informed decision making process between patient and physician to select the most appropriate cartilage repair procedure.

11 Conclusion Thank you for your attention!

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