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Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective study with twelve month follow-up

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A Letter to the Editor to this article was published on 26 January 2022

Abstract

Purpose

To determine the prevalence and change in neuropathic pain or pain catastrophizing before and 12 months following patellar stabilisation surgery for patellofemoral instability.

Methods

We conducted a prospective clinical audit within a UK NHS orthopaedic surgical centre. Data from 84 patients with patellofemoral instability requiring stabilisation were analysed. Fifty percent (42/84) underwent MPFL reconstruction alone, and 16% (13/84) had both trochleoplasty and MPFL reconstruction. Neuropathic pain was assessed using painDETECT score. Pain catastrophizing was assessed using the Pain Catastrophizing Score. The Norwich Patellar Instability (NPI) Score and Kujala Patellofemoral Disorder Score were also routinely collected pre-operatively and one year post-operatively.

Results

At 12 months post-operatively there was a statistically significant reduction in mean Pain Catastrophizing Scores (18.9–15.7; p < 0.02), but no change in mean painDETECT scores (7.3–7.8; p = 0.72). There was a statistically significant improvement in NPI scores (90.2–61.9; p < 0.01) and Kujala Patellofemoral Disorder Scores (48.7–58.1; p = 0.01). The prevalence of pain catastrophizing decreased from 31% pre-operatively to 24% post-operatively, whereas the prevalence of neuropathic pain remained consisted (10–11%).

Conclusions

Neuropathic pain and catastrophizing symptoms are not commonly reported and did not significantly change following patellofemoral stabilisation surgery. Whilst low, for those affected, there remains a need to intervene to improve outcomes following PFI surgery.

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Data availability

Data and statistical code will be released on reasonable request to the corresponding author.

References

  1. Nietosvaara Y, Aalto K, Kallio PE (1994) Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Ped Orthop 14:513–515

    Article  CAS  Google Scholar 

  2. Saccomanno MF, Sircana G, Fodale M, Donati F, Milano G (2016) Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis. Int Orthop 40:2277–2287

    Article  PubMed  Google Scholar 

  3. Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28:472–479

    Article  CAS  PubMed  Google Scholar 

  4. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121

    Article  PubMed  Google Scholar 

  5. Bolgla LA, Boling MC, Mace KL, DiStefano MJ, Fithian DC, Powers CM (2018) National Athletic Trainers’ Association Position Statement: Management of individuals with Patellofemoral Pain. J Athlet Training 53:820–836

    Article  Google Scholar 

  6. Sanders TL, Pareek A, Hewett TE, Stuart MJ, Dahm DL, Krych AJ (2018) High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc 26(4):1037–1043

    PubMed  Google Scholar 

  7. McGuine TA, Winterstein AP, Carr K, Hetzel S (2014) Changes in health-related quality of life and knee function after knee injury in young female athletes. Orthop J Sports Med 2(4):2325967114530988

    Article  PubMed  PubMed Central  Google Scholar 

  8. Smith TO, Donell ST, Chester R, Clark A, Stephenson R (2011) What activities do patients with patellar instability perceive makes their patella unstable? Knee 18:333–339

    Article  PubMed  Google Scholar 

  9. Magnussen RA, Verlage M, Stock E, Zurek L, Flanigan DC, Tompkins M et al (2015) Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing? Knee Surg Sports Traumatol Arthrosc:2–6.

  10. Smith TO, Donell ST, Clark A, Chester R, Cross J, Kader DF et al (2014) The development, validation and internal consistency of the Norwich Patellar Instability (NPI) score. Knee Surg Sports Traumatol Arthrosc 22:324–335

    Article  PubMed  Google Scholar 

  11. Smith TO, Donell S, Song F, Hing CB (2015) Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev 26:CD008106

    Google Scholar 

  12. Subramanian P, Patel R (2016) Patellofemoral instability: an overview. Orthop Traumatol 33:119–126

    Google Scholar 

  13. Rhee SJ, Pavlou G, Oakley J, Barlow D, Haddad F (2012) Modern management of patellar instability. Int Orthop 36:2447–2456

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fingleton C, Smart K, Moloney N, Fullen BM, Doody C (2015) Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 23:1043–1056

    Article  CAS  Google Scholar 

  15. Thakur M, Dickenson AH, Baron R (2014) Osteoarthritis pain: nociceptive or neuropathic? Nat Rev Rheumatol 10:374–380

    Article  PubMed  Google Scholar 

  16. Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:S2–S15

    Article  PubMed  Google Scholar 

  17. Callin S, Bennett MI (2008) Assessment of neuropathic pain. Contin Educ Anaesth Crit Care Pain 8:210–213

    Article  Google Scholar 

  18. Buchanan G, Torres L, Czarkowski B, Giangarra CE (2016) Current concepts in the treatment of gross patellofemoral instability. Int J Sport Phys Ther 11:867–876

    Google Scholar 

  19. de Oliveira V, de Souza V, Cury R, Camargo OP, Avanzi O, Severino N, Fucs P (2014) Medial patellofemoral ligament anato- my: is it a predisposing factor for lateral patellar dislocation? Int Orthop 38:1633–1639

    Article  PubMed  PubMed Central  Google Scholar 

  20. Goubert D, Danneels L, Cagnie B, Van Oosterwijck J, Kolba K, Noyez H et al (2015) Effect of pain induction or pain reduction on conditioned pain modulation in adults: a systematic review. Pain Pract 15:765–777

    Article  PubMed  Google Scholar 

  21. Klyne DM, Schmid AB, Moseley GL, Sterling M, Hodges PW (2015) Effect of types and anatomic arrangement of painful stimuli on conditioned pain modulation. J Pain 16:176–185

    Article  PubMed  Google Scholar 

  22. Kurien T, Arendt-Nielsen L, Petersen KK, Graven-Nielsen T, Scammell BE (2018) Preoperative neuropathic pain-like symptoms and central pain mechanisms in knee osteoarthritis predicts poor outcome 6 months after total knee replacement surgery. J Pain 19:1329–1341

    Article  PubMed  Google Scholar 

  23. Christensen KS, O’Sullivan K, Palsson ST (2020) Conditioned pain modulation efficiency is associated with pain catastrophizing in patients with chronic low back pain. Clin J Pain 36:826–832

    Article  Google Scholar 

  24. Quartana PJ, Campbell CM, Edwards RR (2009) Pain catastrophizing: a critical review. Expert Rev Neurother 9:745–758

    Article  PubMed  PubMed Central  Google Scholar 

  25. Burns LC, Ritvo SE, Ferguson MK, Clarke H, Seltzer Z, Katz J (2015) Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review. J Pain Res 8:21–32

    PubMed  PubMed Central  Google Scholar 

  26. Lewis GN, Rice DA, McNair PJ, Kluger M (2015) Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 114:551–561

    Article  CAS  PubMed  Google Scholar 

  27. Sanchis-Alfonso V, Puig-Abbs C, MartÍnez-Sanjuan V (2011) Evaluation of the patient with anterior knee pain and patellar instability. In: Sanchis-Alfonso V (ed) Anterior knee pain and patellar instability. Springer, London, pp 105–133

    Chapter  Google Scholar 

  28. Thompson P, Metcalfe AJ (2019) Current concepts in the surgical management of patellar instability. Knee 26:1171–1181

    Article  PubMed  Google Scholar 

  29. Beighton PH, Horan F (1969) Orthopedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg [Br] 51:444–453

    Article  CAS  Google Scholar 

  30. Reider B, Marshall JL, Warren RF (1981) Clinical characteristics of patellar disorders in young athletes. Am J Sports Med 9:270–274

    Article  CAS  PubMed  Google Scholar 

  31. Sheehan FT, Derasari A, Fine KM, Brindle TJ, Alter KE (2010) Q-angle and J-sign: indicative of maltracking subgroups in patellofemoral pain. Clin Orthop Relat Res 468:266–275

    Article  PubMed  Google Scholar 

  32. Sullivan MJL, Bishop S, Pivik J (1995) The Pain Catastrophizing Scale: Development and validation. Psychol Assess 7:524–532

    Article  Google Scholar 

  33. Freynhagen R, Baron R, Gockel U, Tolle TR (2006) painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 22:1911–1920

    Article  PubMed  Google Scholar 

  34. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    Article  CAS  PubMed  Google Scholar 

  35. Bennett MI, Attal N, Backonja MM et al (2007) Using screening tools to identify neuropathic pain. Pain 127:199–203

    Article  PubMed  Google Scholar 

  36. Bouhassira D, Attal N (2011) Diagnosis and assessment of neuropathic pain: the saga of clinical tools. Pain 152(3 Suppl):S74-83

    Article  PubMed  Google Scholar 

  37. Lavand’homme PM, Grosu I, France MN, et al (2014) Pain trajectories identify patients at risk of persistent pain after knee arthroplasty: an observational study. Clin Orthop Relat Res 472:1409–1415

    Article  Google Scholar 

  38. Priore LB, Azevedo FM, Pazzinatto MF, Ferreira AS, Hart HF, Barton C et al (2019) Influence of kinesiophobia and pain catastrophism on objective function in women with patellofemoral pain. Phys Therap Sport 35:116–121

    Article  Google Scholar 

  39. Jockimsen KN, Pelton MR, Mattacloa CG, Huston LJ, Reinke EK, Spindler KP et al (2019) Relationship between pain catastrophizing and 6-month outcomes following anterior cruciate ligament reconstruction. J Sport Rehabil 18:1–5

    Google Scholar 

  40. Campbell CM, Buenaver LF, Finan P, Bounds SC, Redding M, McCauley L, Robinson M et al (2015) Sleep, pain catastrophizaing and central sensitization in knee osteoarthritis patients with and without insomnia. Arthritis Care Res 67:1387–1396

    Article  Google Scholar 

  41. Jensen R, Hystad T, Kvale A, Baerheim A (2007) Quantitative sensory testing of patients with long lasting patellofemoral pain syndrome. Eur J Pain 11:665–676

    Article  PubMed  Google Scholar 

  42. Sulllivan MJL, Stanish W, Waite H, Sullivan M, Tripp DA (1998) Catastrophizing, pain and disability in patients with soft-tissue injuries. Pain 77:253–260

    Article  Google Scholar 

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Funding

The authors received no funding to undertake this work.

Author information

Authors and Affiliations

  1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK

    T. O. Smith

  2. Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK

    T. O. Smith

  3. St George’s University Hospitals NHS Foundation Trust, London, UK

    A. Choudhury, D. Tennent & C. B. Hing

  4. St George’s University London, London, UK

    A. Choudhury & J. Fletcher

  5. London Business School, Research Laboratory, London, UK

    Z. Choudhury

  6. Pain Research Cluster; Ageing, Acute and Long Term Conditions Research Group, Institute of Health and Social Care, London South Bank University, London, UK

    M. Mansfield

Authors
  1. T. O. Smith
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  2. A. Choudhury
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  3. J. Fletcher
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  4. Z. Choudhury
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  5. M. Mansfield
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  6. D. Tennent
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  7. C. B. Hing
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Contributions

Toby O Smith: Study analysis, preparation and review of the manuscript.

Aliya Choudhury: Data gathering, study analysis and preparation of the manuscript.

Joshua Fletcher: Preparation and review of manuscript.

Zareen Choudhury: Preparation and review of manuscript.

Michael Mansfield: Preparation and review of manuscript.

Duncan Tennent: Preparation and review of manuscript.

Caroline B Hing: Study design, preparation and review of the manuscript.

Corresponding author

Correspondence to T. O. Smith.

Ethics declarations

Ethical approval

Approval for this clinical audit was obtained from the XXXXX Hospital (XXXXX) Clincal Audit Department (Ref: AUDI000887).

Consent to participants

Consent for participants was obtained as part of the audit approval consent processes.

Consent for publication

Consent for publication from participants was obtained as part of the audit approval consent processes.

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No conflict of interest to declare.

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Smith, T.O., Choudhury, A., Fletcher, J. et al. Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective study with twelve month follow-up. International Orthopaedics (SICOT) 45, 1745–1750 (2021). https://doi.org/10.1007/s00264-021-05046-w

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  • DOI: https://doi.org/10.1007/s00264-021-05046-w

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