Multi-region anterior knee pain is associated with poorer subjective athletic performance following anterior cruciate ligament reconstruction: an exploratory cross-sectional study

Anterior knee pain (AKP) is a common complication after anterior cruciate ligament (ACL) reconstruction and may affect post-operative functional outcomes. However, the relationship between the AKP region and patient-reported outcome measures (PROMs) remains unclear. The aim of this study was to examine whether multi-region AKP is associated with poorer PROMs than single region or no AKP following ACL reconstruction. This exploratory cross-sectional study included 35 athletes who returned to sport following primary unilateral ACL reconstruction [median age 20.0 years (interquartile range 5.0 years); mean ± standard deviation time since surgery 11.8 ± 2.3 months]. Knee pain locations were identified using a photographic knee pain map and were classified into five categories: no AKP, medial, central, lateral, and multi-region. Post-operative subjective athletic performance (PoSAP) intensity and the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale were used as PROMs. Differences in patient-reported outcomes across the five pain location groups were analyzed using the Kruskal–Wallis test and Dunn's post hoc test. Dunn's test showed that the multi-region pain group had significantly lower PoSAP scores than the no AKP group (adjusted p = 0.029; r = 0.589). However, the Kruskal–Wallis test revealed no significant differences in ACL-RSI scores among the groups with different AKP locations. Individuals with AKP affecting multiple regions perceive poorer post-operative athletic performance after ACL reconstruction than those without AKP. These findings underscore the importance of assessing whether AKP has affected multiple regions, in addition to pain intensity, when evaluating post-operative recovery. • Exploratory study examining association of multi-region anterior knee pain (AKP) with PROMs after ACL reconstruction. • Athletes with multi-region AKP had significantly lower subjective athletic performance scores. • Despite the limited sample size, findings suggest multi-region AKP may impact post-operative recovery. • Photographic knee pain map enabled identification of pain distribution patterns associated with poorer outcomes.