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Central sensitization negatively influences the level of disability in female patients with anterior knee pain

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To define the prevalence of Central Sensitization (CS) in patients with Anterior Knee Pain (AKP) and determine whether there is an association between CS and the magnitude of pain, disability, quality-of-life and psychological impairment.

Methods

The data of a total of 44 AKP female patients with a mean age of 27.7 years (15–50) recruited consecutively from hospital outpatient knee clinics were prospectively included in this study. The patients had no antecedents of knee trauma or surgery and no history of injury or disease of the nervous system. There were also 50 healthy female controls with a mean age of 26.1 years (16–46). CS was evaluated using the Central Sensitization Inventory (CSI). Quality-of-life was evaluated using the EuroQoL-5D questionnaire. Self-reporting of clinical pain intensity was obtained using the Visual Analogue Scale. The Kujala Knee Scale and IKDC form were used to evaluate disability. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Subscale (HAD). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK-11) and catastrophizing by means of the Pain Catastrophizing Scale (PCS).

Results

Sixteen AKP patients (36%), and 2 (4%) of the healthy controls presented with central sensitization (p < 0.01). AKP patients with CS have a greater degree of disability based on the Kujala Scale and higher levels of anxiety and depression than AKP patients without CS. The score of AKP patients in the CSI correlated weakly with disability and quality of life and moderately with anxiety and depression. However, no association was seen between CSI score and pain intensity, nor with catastrophizing and kinesiophobia. A multivariate logistic regression analysis showed that only depression was statistically significant in the prediction of the presence of CS (odds ratio 1.45; 95% CI 1.07 to 1.96).

Conclusions

AKP patients have a significantly higher prevalence of CS in comparison with what has been reported for the general population. This finding suggests the presence of altered pain modulation in a subgroup of AKP patients.

Level of evidence

Level III.

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Data availability

The data that support the findings of this study are available from the authors upon reasonable request.

Abbreviations

AKP:

Anterior knee pain

CS:

Central sensitization

CSI:

Central sensitization inventory

CNS:

Central nervous system

HAD:

Hospital anxiety and depression subscale

PCS:

Pain catastrophizing scale

TSK:

Tampa scale for kinesiophobia

VAS:

Visual analogue scale

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/San Clemente 12, 46015, Valencia, Spain

    Vicente Sanchis-Alfonso & Alejandro Roselló-Añón

  2. GIBI230 Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain

    María Beser-Robles

  3. Department of Rehabilitation and Physical Therapy, Hospital Arnau de Vilanova, Valencia, Spain

    Ana Navarro-Calvo & Laura López-Company

  4. Department of Orthopedic Surgery, Clínica Universidad de Navarra, Pamplona, Spain

    Julio Domenech-Fernández

Authors
  1. Vicente Sanchis-Alfonso
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  2. María Beser-Robles
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  3. Ana Navarro-Calvo
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  4. Laura López-Company
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Correspondence to Vicente Sanchis-Alfonso.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

The research ethics committee of our intitution (Hospital Arnau de Vilanova) reviewed and approved this study (PI2_2023/CEIm:5/2023).

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Sanchis-Alfonso, V., Beser-Robles, M., Navarro-Calvo, A. et al. Central sensitization negatively influences the level of disability in female patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 31, 5381–5387 (2023). https://doi.org/10.1007/s00167-023-07591-w

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