Prevalence of anterior knee pain in post-operative multi-ligamentous knee reconstruction individuals

Background: Multi-ligamentous knee injuries (MLKI) represent complex orthopedic conditions involving damage to two or more primary knee ligaments (ACL, PCL, MCL, LCL), typically resulting from high-energy trauma such as motor vehicle accidents or severe sports injuries. While anterior knee pain following single ligament reconstruction is well-documented with prevalence rates of 5-19%, there exists a significant knowledge gap regarding anterior knee pain occurrence in multi-ligamentous reconstruction patients. These complex procedures involve extensive surgical intervention and present unique biomechanical challenges that may predispose patients to different pain patterns compared to single-ligament procedures. Understanding the prevalence and associated factors of anterior knee pain in this specialized population is crucial for optimizing patient counselling, developing targeted prevention strategies, and implementing appropriate rehabilitation protocols. Materials and Methods: A 6-month survey-based observational study involving 90 participants (aged 16-45) who underwent multi-ligamentous knee reconstruction and presented with anterior knee pain ≥5/10 on NPRS. Assessment included the Kujala anterior knee pain scale, NPRS evaluation, ROM assessment, and quadriceps strength measurement using dynamometry. Results: Mean NPRS scores were 5.51 ± 1.03 (range 3-7). Severe muscle atrophy was present in 73% of participants with a 67% strength reduction compared to the minimal atrophy group (H(2) = 43.21, p < .001). Significant ROM deficits were observed, with severe flexion deficiency showing a 40% reduction (F(2,87) = 22.43, p < .001) and extension deficits (F(2,87) = 74.32, p < .001). No significant associations were found between gender and limp presence (p = .492) or knee-side pain frequency (p = .910). Conclusion: This first comprehensive study of anterior knee pain in multi-ligamentous reconstruction patients revealed 100% prevalence of clinically significant pain, with 73% showing severe quadriceps atrophy. Strong associations between pain, muscle atrophy, and ROM deficits indicate anterior knee pain is a prevalent outcome requiring proactive management. Clinical implications include preoperative counselling, aggressive early mobilization protocols, and comprehensive multidisciplinary pain management strategies for optimal patient outcomes.