Preoperative anxiety before anterior cruciate ligament reconstruction is a risk factor of post-operative pain

The study investigates whether preoperative anxiety, measured by the Surgical Fear Questionnaire (SFQ), influences post-operative pain following anterior cruciate ligament (ACL) reconstruction.

A retrospective analysis of prospective data was performed, including 628 patients operated on for primary ACL reconstruction between October 2023 and July 2024. Patients were classified as low anxiety (SFQ < 30) and high anxiety (SFQ ≥ 30). Two groups were created for comparison and paired for age, sex and preoperative Lysholm score. The primary outcome was post-operative pain evaluated by the visual analogue scale (VAS) at different intervals (Days 0-3). The secondary outcome measure was the percentage of patients who crossed the Patient Acceptable Symptom State (PASS) threshold for the VAS in both groups at the same points in time.

A total of 628 patients were evaluated, and after one-to-one propensity score matching based on age, sex, and preoperative Lysholm score, 334 patients (167 in the low SFQ group and 167 in the high SFQ group) were included in the final analysis. The mean age was 31.6 (9.6) years. The VAS scores were significantly different between the two groups. The high anxiety group had a higher level of post-operative pain at all time points (Day 0: p = 0.002; Day 1: p < 0.001; Day 2: p < 0.001; Day 3: p < 0.001). A significantly greater proportion (p < 0.005) of patients in the low SFQ group crossed the PASS threshold compared to the high SFQ group at all times. The greatest difference was observed on Day 3 with 64.1% of the patients in the low SFQ group crossing the PASS threshold, compared to only 45.5% in the high SFQ group.

High preoperative anxiety is a risk factor for post-operative pain following ACL reconstruction. These results highlight the importance of preoperative anxiety screening and targeted psychological support as part of prehabilitation protocols to reduce early post-operative pain and potentially enhance recovery following ACL reconstruction.

Cohort study.

Level III.