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Low central sensitisation inventory score is associated with better post-operative outcomes of osteotomy around the knee



The purpose of this study was to investigate the potential association between central sensitisation inventory (CSI) scores and post-operative patient-reported outcomes (PROs) in patients underwent osteotomy around the knee (OAK), with a CSI cut-off score specific for knee osteoarthritis.


CSI scores were collected from 173 patients who underwent OAK, along with their knee injury and osteoarthritis outcome score (KOOS) and pain numeric rating scale (NRS) scores. Patients were divided into high-CSI score group and low-CSI score group with a cut-off score of 17. Multivariate linear regression was performed to test the association between CSI scores and post-operative outcomes. Pre-surgery KOOS and NRS scores and the rate of attainment of minimal clinically important difference (MCID) of KOOS scores was analysed as secondary outcomes.


Low-CSI score group had significantly higher post-operative KOOS scores and lower pain NRS scores compared to the high-CSI score group (< p = 0.01) after adjusting for confounding factors. For pre-operative scores, only the KOOS-Symptom score was significantly different between the groups (64.7 ± 20.1 when CSI < 17 vs.55.1 ± 19.7 when CSI ≥ 17; p = 0.008). The low-CSI score group had significantly higher MCID achievement rates of KOOS-Pain, Symptom, and ADL than the high-CSI score group (86% vs. 68%; 74% vs. 55%; 86% vs. 67%, respectively; P < 0.05).


This study established an association between post-operative CSI scores ≥ 17 and poorer outcomes following OAK, highlighting the potential value of the CSI in identifying patients in need of more comprehensive peri-operative pain management.

Level of evidence

Level III. Retrospective comparative study.

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Data availability

The data that support the findings of this study are available from the corresponding author, [YN], upon reasonable request


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The authors thank Toshitaka Yoshii, MD, PhD and Ichiro Sekiya, MD, PhD for continuous support; Miyoko Ojima and Masayo Tsukamoto for organizing data.


This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations



HD conceived the study, managed data, performed statistical analysis, participated in study design and wrote the manuscript. HKo acquisition of data, participated in study design, interpreted results and, providing the administrative and financial support. HKa managed data and interpretation of data. SH managed data, interpretation of data and edited the manuscript. TA interpreted results, and performed statistical analysis. MK participated in study design and interpreted results. AY, MA, TH, NO, and TN acquisition of data. YN acquisition of data, participated in study design, interpreted results, edited the manuscript and had full access to all of the data in the study and final approved manuscript. All authors read, approved the final manuscript and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Yusuke Nakagawa.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board in Tokyo Medical and Dental University (research protocol identification number: M2018-133).

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All study participants provided their full written informed consent for participation in this clinical research prior to the operative procedure.

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Ding, H., Koga, H., Katagiri, H. et al. Low central sensitisation inventory score is associated with better post-operative outcomes of osteotomy around the knee. Knee Surg Sports Traumatol Arthrosc (2023).

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