Association of Self-Reported Anxiety and Depression Symptoms with Knee Pain Severity in Individuals with Anterior Cruciate Ligament Reconstruction
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Psychological responses to injury are common after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) and have been linked to knee-related pain during early recovery. However, it remains unknown whether anxiety and depression symptoms are associated with knee pain severity at later stages of recovery, when unresolved or recurrent psychological distress may persist. Purpose/Hypothesis: The purpose of this study was to examine the association of anxiety and depression symptoms with knee pain severity in individuals 3 to 12 months after ACLR. It was hypothesized that individuals who exhibited more severe anxiety and depression symptoms would report more knee pain. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In total, 131 individuals who were 3 to 12 months after primary, unilateral ACLR (time since ACLR = 5.7 ± 1.7 months; age = 18.3 ± 2.1 years; 37.4% male) were included. Anxiety and depression symptoms were measured with the Patient-Reported Outcomes Measurement Information System Anxiety and Depression 4-item short forms, respectively, where higher scores reflect more severe symptoms. Knee pain was measured with the Knee injury and Osteoarthritis Outcome Score Pain subscale, where higher scores indicate less or no knee pain. Separate multiple hierarchical regression analyses were conducted to examine the association of self-reported anxiety and depression symptoms with knee pain severity. Sex, age, and time since ACLR were entered in step 1 of each model. Anxiety and depression symptom scores were entered in step 2 of their respective models, and the change in R 2 was examined. Results: Sex, age, and time since ACLR explained 3% of the variance in knee pain severity ( R 2 = 0.031, P = .23). Anxiety symptoms accounted for an additional 25.7% of the variance in knee pain severity (Δ R 2 = 0.257, P < .001), while depression symptoms accounted for an additional 15.7% of the variance in knee pain severity (Δ R 2 = 0.157, P < .001). Conclusion: Self-reported anxiety and depression symptoms were significantly associated with knee pain severity in individuals 3 to 12 months after ACLR. These findings support assessment of anxiety, depression, and knee pain, even in the later phases of ACLR rehabilitation, to help inform clinical decision-making.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
Funders: American Diabetes Association, National Aeronautics and Space Administration, Bill and Melinda Gates Foundation, Welch Foundation, American Heart Association, V Foundation for Cancer Research, Research to Prevent Blindness, American Lung Association, Cancer Prevention and Research Institute of Texas, American Association of University Women, National Geographic Society, Boston University, National Foundation for Science and Technology Development, Takeda Science Foundation, Michigan State University, Rice University, Louisiana State University, Pennsylvania State University, Prince Sattam bin Abdulaziz University, Wellcome Trust, Rural and Environment Science and Analytical Services Division, Maryland Stem Cell Research Fund, Okinaka Memorial Institute for Medical Research, Chan Zuckerberg Initiative, Science and Technology Department of Xinjiang Uygur Autonomous Region, Regional Centre for Biotechnology, Royal Society, British Council, Royal Society of Chemistry, European Commission, Indian Council of Medical Research, Council of Scientific and Industrial Research, India, University College Dublin, Deutsche Forschungsgemeinschaft, Volkswagen Foundation, Agence Nationale de la Recherche, Keio University, Canada Research Chairs, National Natural Science Foundation of China, King Saud University, Austrian Science Fund, Centre National d’Etudes Spatiales, China Postdoctoral Science Foundation, Nederlandse Organisatie voor Wetenschappelijk Onderzoek, Natural Science Foundation of Fujian Province, National Research Foundation of Korea, International Atomic Energy Agency, Natural Science Foundation of Guangxi Province, Youth Innovation Promotion Association of the Chinese Academy of Sciences, Deutsches Zentrum für Neurodegenerative Erkrankungen, Umm Al-Qura University, Natural Science Foundation of Shandong Province, Mansoura University, University Grants Commission- Nepal, Temasek Life Sciences Laboratory, Renji Hospital, Norges Astma- og Allergiforbund, Macaulay Development Trust, Ministero dell'Università e della Ricerca, National Institutes of Health, Office of the Director, Office of Energy Efficiency and Renewable Energy, College of Engineering, Michigan State University, National Outstanding Youth Science Fund Project of National Natural Science Foundation of China, HORIZON EUROPE Framework Programme, Canadian Institutes of Health Research, Natural Environment Research Council, Australian Research Council, Japan Society for the Promotion of Science, Japan Science and Technology Agency, Agencia Nacional de Promoción Científica y Tecnológica, School of Medicine, Keio University, National Key Research and Development Program of China, Fundamental Research Funds for the Central Universities, National College Students Innovation and Entrepreneurship Training Program, National Institute on Aging, Office of Naval Research, National Institute of Mental Health, National Institute of Diabetes and Digestive and Kidney Diseases, U.S. National Library of Medicine, HORIZON EUROPE European Research Council, National Science Foundation Graduate Research Fellowship Program, Mangosuthu University of Technology
OpenAlex ID: W7163132880