Presurgical Evaluation by a Health Behavior Psychologist Can Effectively Delineate Patient-Specific Barriers that Impact Treatment Outcomes after Osteochondral Allograft Transplantation

Abstract

Osteochondral allograft transplantation (OCAT) is an effective treatment option for young, active patients with full-thickness articular cartilage defects, but long-term success is limited by treatment failures often linked to nonadherence to postoperative protocols. Validated methods for preoperative identification of patients at risk for nonadherence and/or poor outcomes following OCAT are limited. This study aimed to characterize the ability of a health behavior psychologist (HBP) to preoperatively delineate patient-specific barriers associated with nonadherence and failure following OCAT. Patients were prospectively enrolled in a lifelong, institutionally approved registry. Patients were eligible for inclusion if they had a preoperative evaluation with an HBP. Demographic, biopsychosocial, patient-reported outcomes surveys, and adherence status were collected. Risk domains (low, medium, high) were assigned by the HBP based on the presence and severity of barriers identified during HBP evaluations. OCAT patients (n = 99) were evaluated and assigned a risk domain: (low-risk [n = 41], medium-risk [n = 44], high-risk [n = 14]). Patients in medium- and high-risk cohorts reported significantly more barriers, including mental health issues, limited social support, and high-demand occupations, compared with low-risk patients. Nonadherence rates were significantly higher in medium- and high-risk cohorts; however, nonadherence was not significantly associated with treatment failure. The low-risk cohort reported better mental health and satisfaction outcomes, whereas medium- and high-risk patients had worse physical health outcomes. Preoperative HBP evaluations effectively identified patient-specific barriers to adherence, enabling targeted interventions to improve OCAT surgery outcomes. Integrating behavioral health support into orthopaedic care may improve adherence, highlighting the need for broader implementation and further studies.

Level of Evidence 2, prospective cohort study

Keywords

orthopaedics - nonadherence - biopsychosocial - mental health - behavioral health

Publikationsverlauf

Eingereicht: 08. April 2025

Angenommen: 21. April 2025

Accepted Manuscript online:
22. April 2025

Artikel online veröffentlicht:
22. Mai 2025

• References

• 1 Cook JL, Rucinski K, Crecelius C, Fenkell B, Stannard JP. Assessment of outcomes after multisurface osteochondral allograft transplantations in the knee. Orthop J Sports Med 2022; 10 (06) 23 259671221102452
• 2 Familiari F, Cinque ME, Chahla J. et al. Clinical outcomes and failure rates of osteochondral allograft transplantation in the knee: a systematic review. Am J Sports Med 2018; 46 (14) 3541-3549
• 3 Gross AE, Kim W, Las Heras F, Backstein D, Safir O, Pritzker KPH. Fresh osteochondral allografts for posttraumatic knee defects: long-term followup. Clin Orthop Relat Res 2008; 466 (08) 1863-1870
• 4 Gross CE, Adams Jr SB, Easley ME, Nunley JA. Role of fresh osteochondral allografts for large talar osteochondral lesions. Instr Course Lect 2016; 65: 301-309
• 5 Stannard JP, Cook JL. Prospective assessment of outcomes after primary unipolar, multisurface, and bipolar osteochondral allograft transplantations in the knee: a comparison of 2 preservation methods. Am J Sports Med 2020; 48 (06) 1356-1364
• 6 Buyuk AF, Stannard JP, Rucinski K, Crecelius CR, Cook JL. The Missouri Osteochondral Preservation System is associated with better short-term outcomes than standard preservation methods when performing osteochondral allograft transplantation using shell grafts for patellofemoral lesions. Arthroscopy 2023; 39 (03) 650-659
• 7 Rucinski K, Cook JL, Crecelius CR, Stucky R, Stannard JP. Effects of compliance with procedure-specific postoperative rehabilitation protocols on initial outcomes after osteochondral and meniscal allograft transplantation in the knee. Orthop J Sports Med 2019; 7 (11) 2325967119884291
• 8 Rucinski K, Stucky R, Crecelius CR, Stannard JP, Cook JL. Effects of patient assessment and education by an integrated care team on postoperative adherence and failure rates after osteochondral allograft and meniscal allograft transplantation in the knee. Orthop J Sports Med 2023; 11 (05) 23 259671231160780
• 9 Rucinski K, Cook JL, Royse LA. The complexity of patient adherence in orthopaedics: a qualitative study to identify barriers and develop strategies for adherence partnerships. Musculoskeletal Care 2023; 21 (04) 1387-1400
• 10 Bedeir YH, Hasselfeld KA, Kuechly HA. et al. Risk factors associated with ACL registry compliance: can we predict who will follow-up?. Eur J Orthop Surg Traumatol 2019; 29 (03) 645-650
• 11 Rucinski K, Leary E, Crist BD, Cook JL. Orthopaedic trauma patient non-adherence to follow-up visits at a level 1 trauma center serving an urban and rural population. Injury 2023; 54 (03) 880-886
• 12 Salim A, Ottochian M, DuBose J. et al. Does insurance status matter at a public, level I trauma center?. J Trauma 2010; 68 (01) 211-216
• 13 Zelle BA, Buttacavoli FA, Shroff JB, Stirton JB. Loss of follow-up in orthopaedic trauma: who is getting lost to follow-up?. J Orthop Trauma 2015; 29 (11) 510-515
• 14 Ferrari R, Louw D. Coping style as a predictor of compliance with referral to active rehabilitation in whiplash patients. Clin Rheumatol 2011; 30 (09) 1221-1225
• 15 Flanigan DC, Everhart JS, Glassman AH. Psychological factors affecting rehabilitation and outcomes following elective orthopaedic surgery. J Am Acad Orthop Surg 2015; 23 (09) 563-570
• 16 Fama CA, Chen N, Prusik J. et al. The use of preoperative psychological evaluations to predict spinal cord stimulation success: our experience and a review of the literature. Neuromodulation 2016; 19 (04) 429-436
• 17 Flores CA. Psychological assessment for bariatric surgery: current practices. Arq Bras Cir Dig 2014; 27 (Suppl. 01) 59-62
• 18 O'Brien PE, Hindle A, Brennan L. et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg 2019; 29 (01) 3-14
• 19 Snyder AG. Psychological assessment of the patient undergoing bariatric surgery. Ochsner J 2009; 9 (03) 144-148
• 20 Rothrock NE, Kaat AJ, Vrahas MS. et al. Validation of PROMIS physical function instruments in patients with an orthopaedic trauma to a lower extremity. J Orthop Trauma 2019; 33 (08) 377-383
• 21 Hays RD, Schalet BD, Spritzer KL, Cella D. Two-item PROMIS® global physical and mental health scales. J Patient Rep Outcomes 2017; 1 (01) 2
• 22 Askew RL, Cook KF, Revicki DA, Cella D, Amtmann D. Evidence from diverse clinical populations supported clinical validity of PROMIS pain interference and pain behavior. J Clin Epidemiol 2016; 73: 103-111
• 23 Higgins LD, Taylor MK, Park D. et al; International Knee Documentation Committee. Reliability and validity of the International Knee Documentation Committee (IKDC) Subjective Knee Form. Joint Bone Spine 2007; 74 (06) 594-599
• 24 Haff RE, Stoltzfus J, Lucente VR, Murphy M. The Surgical Satisfaction Questionnaire (SSQ-8): a validated tool for assessment of patient satisfaction following surgery to correct prolapse and/or incontinence. J Minim Invasive Gynecol 2011; 18 (06) S49-S50
• 25 Williams J, Rucinski K, Stucky R. et al. Enrollment in a behavioral health program positively impacts 2-year cumulative survival rates in osteochondral allograft transplant patients. J Knee Surg 2025; 38 (01) 28-34