Science and Innovations in Medicine, Vol 10, No 2 (2025)

Aim – to evaluate the incidence and risk factors of chronic post-traumatic pain in patients who suffered an anterior cruciate ligament (ACL) and/or knee joint meniscus (CC) injury.

Material and methods. The study group consisted of 148 patients (48.0% women, 37.9 ± 13.1 years old) who had suffered an injury to the PC and/or meniscus of the CS, confirmed by magnetic resonance imaging (MRI). The inclusion criterion was moderate/severe pain (≥4 on the numerical rating scale, NRS 0-10) 1 month after the injury. Patients were examined after 3, 6, and 12 months with an assessment of pain (NRS) and the KOOS index, signs of neuropathic pain (painDETECT), anxiety and depression (HADS a and HADS d), central sensitization index (CSI), pain catastrophization (PCS), fibromyalgia symptoms (FiRST), fatigue (FACIT). An MRI scan was performed after 6 and 12 months. The plasma concentrations of a number of biomarkers (HCRP, NTX, ADAMTS-5, COMP, MMP3, MMP9, MMP13, substance P) were studied.

Results. After 3 months, pain with movement ≥4 NRS was observed in 58 (39.2%) patients. These patients formed the group with chronic post-traumatic pain (CPTP+), patients with lower pain intensity or absence (≤4 NRS) formed the control group (CPTP-). In patients with CPTP+, compared with the CPTP- group, pain at rest and at night was significantly higher (p <0.001). A significant difference in pain during movement, at rest, and at night, as well as all KOOS scales, remained between the CPTP+ and CPTP- groups after 6 and 12 months. In the CPTP+ group, there was a tendency to a higher frequency of signs of neuropathic pain, anxiety and depression, central sensitization index, pain catastrophization scale and fatigue, however, the difference with the CPTP- group was unreliable. The concentration of biomarkers in the CPTP+ and CPTP- groups did not differ. There was a significant association between CPTP and the female sex (odds ratio = 3.18; 95% confidence interval 1.606-6.297, p<0.001), meniscus injury (OR = 2.132; 95% CI 1.07-4.252, p=0.03), osteitis (OR = 5.734; 95% CI 2.106-15.609, p<0.001) and synovitis (OR = 2.35; 95% CI 1.186-4.656, p=0.013) according to MRI, surgery (reduced the risk of CPTP, OR = 0.385; 95% CI 0.195-0.759, p<0.005), initially severe pain (≥7 NRS, OR = 5.553; 95% CI 1.696-18.179, p=0.002), signs of highly probable CS (CSI ≥40, OR = 3.915; 95% CI 1.147-13.368, p=0.021) and severe depression (HADS ≥ 11, OR = 4.12; 95% CI 1.672-21.983, p=0.05).

Conclusion. CPTP occurs in almost 40% of patients after knee joint meniscus injury. Risk factors for CPTP are female gender, meniscus injury, osteitis and synovitis (MRI data), initially severe pain, central sensitization, and depression.