Preoperative Pain Perceptions Are Predictive of Physical Therapy Performance, Healthcare Resource Utilization, and Postoperative Symptoms After Anterior Cruciate Ligament Reconstruction


      Certain psychological traits including anxiety or fear of pain, individual differences in pain coping strategies, and severe subjective pain prior to surgery can adversely affect outcomes after elective orthopaedic surgery. This study investigated the predictive effect of preoperative pain perceptions phyiscal therapy performance, healthcare resource utilization, and persistent symptoms after anterior cruciate ligament (ACL) reconstruction.


      A total of 72 patients who underwent ACL reconstruction completed a battery of preoperative self- administered survey instruments related to subjective pain, subjective knee symptoms (IKDC), anxiety related to pain (PCS), fear of reinjury or pain from movement ( TSK and FABQ), pain coping methods (brief COPE, and PCM). The association between these preoperative scores and number of post-operative pain scripts, office visits, office telephone encounters, re-injury and return to sport within 12 months as well as physical therapist documented effort were analyzed.


      Increased preoperative pain scores were predictive of a higher requested number of post-operative pain scripts (R-square 0.10, p=0.007), pain-related telephone encounters in the first month (p=0.002) and decreased return to sport (p=0.04). High pain catastrophizing scores (PCS) and kinesiophobia scoreswere associated with poor perceived effort in rehabilitation (p=0.002 and p=0.04), decreased rates of return to sport (p=0.001 and p=0.03), and increased re-injury rates (p=0.04 and p=0.02). High IKDC scores were predictive of post-operative complications (p= 0.01), total number of pain scripts (p=0.02), and number of telephone encounters in the first year (p=0.005). Score on the PCM emotion focused items were predictive of total number of pain scrips filled (p= 0.03) and number of telephone encounters in the first year (p= 0.03).


      Preoperative pain perceptions are significantly associated with effort in physical therapy, and functional outcomes. Maladaptive pain perceptions appear to be predictive of higher healthcare resource utilization post-operatively as well as higher re-injury rates.