Multidimensional Assessment–Based Individualized Pain Management Is Associated With Improved Functional Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective Non-Randomized Comparative Study

Zhang YingZuo XianhongGuo LiwenZheng GuoqingJia Yongli^*

• The First Affiliated Hospital of Hebei North University, Zhangjiakou, China

Abstract Background: Postoperative pain after anterior cruciate ligament (ACL) reconstruction is a major barrier to early rehabilitation and functional recovery. Conventional analgesic protocols are typically standardized and may not adequately account for individual variability in pain sensitivity, psychological status, and inflammatory response. This study aimed to evaluate the association between a multidimensional assessment–guided individualized pain management strategy and postoperative analgesic, inflammatory, functional, and psychological outcomes after ACL reconstruction. Methods: This prospective, non-randomized comparative study included 115 patients undergoing primary ACL reconstruction. Analgesic strategies were not randomly assigned. Based on a preoperative multidimensional assessment—including pain threshold testing, psychological evaluation using the Hospital Anxiety and Depression Scale (HADS) and Pain Catastrophizing Scale (PCS), and measurement of inflammatory markers [C-reactive protein (CRP) and interleukin-6 (IL-6)]—patients were allocated to either an individualized pain management group (n = 58) or a conventional control group (n = 57). Postoperative outcomes assessed up to 12 weeks included pain intensity measured by the visual analog scale (VAS), functional recovery evaluated using the International Knee Documentation Committee (IKDC) score, Lysholm score, and knee range of motion (ROM), serum inflammatory cytokines (CRP, IL-6, and tumor necrosis factor-α [TNF-α]), psychological indices, and patient satisfaction. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors of good pain control, defined as VAS ≤ 3. Results: Compared with the control group, the individualized group showed significantly lower VAS scores at all postoperative time points (P < 0.001) and reduced opioid consumption by 32%. Functional outcomes improved (IKDC: 83.6 ± 7.4 vs. 76.9 ± 8.1; Lysholm: 86.2 ± 6.8 vs. 78.5 ± 7.4; both P < 0.001), and knee ROM was greater (132.5° ± 7.3° vs. 123.1° ± 8.9°, P < 0.001). On postoperative day 3, CRP and IL-6 levels were significantly lower (both P < 0.001), and IL-6 correlated positively with pain intensity (r = 0.43, P < 0.01). , The final predictive model achieved excellent discrimination (AUC = 0.89, 95% CI: 0.83–0.95). Conclusions: Multidimensional assessment–based individualized pain management significantly improves analgesic efficacy, reduces inflammation, and accelerates functional recovery after ACL reconstruction.