Purpose
To determine whether the preoperative diagnosis of depression predicted worse postoperative
outcomes, including physical therapy (PT) compliance, return-to-sport, and patient-reported
outcomes using the Patient-Reported Outcomes Measurement Information System (PROMIS)
after anterior cruciate ligament (ACL) reconstruction.
Methods
A multisurgeon series of consecutive patients who had undergone ACL reconstruction
with minimum 2-year follow-up were included. Chart review was conducted to determine
depression diagnosis status, demographic data, rehabilitation PT compliance, return
to sports, and patient-reported outcome data using PROMIS. Patients who met the PROMIS
threshold for mild depression but did not carry a clinical diagnosis of depression
were classified as “situationally depressed.”
Results
Ninety-five of 115 consecutive patients (81%) met inclusion criteria with an average
follow-up of 34 ± 1.9 months. Fourteen patients (15%) had a preoperative diagnosis
of depression, whereas 21 (22%) were considered situationally depressed. Clinically
depressed patients had a greater rate of PT noncompliance (33.2% ± 17.6% vs 21.9%
± 12.6%; P = .02) and a lower postoperative PROMIS Physical Function (50.8 ± 7.7 vs 57.8 ± 11.0;
P = .03 compared with patients without depression. Situationally depressed patients
had lower preoperative physical function (35.4 vs 42.5; P = .04) with no differences in postoperative outcomes scores compared to the non-depressed
cohort.19/21 (90.5%) of situationally depressed patients had postoperative resolution
of their depressive symptoms.
Conclusions
Situationally depressed patients without a clinical diagnosis of depression can expect
significant improvements in both pain and function, as well as a resolution of their
depressed mood based on PROMIS scores as they progress through recovery after ACL
reconstruction. Clinically depressed patients also experience significant improvements;
however, their rate of achieving the minimum clinically important difference for PROMIS
outcomes may be less than their nondepressed or situationally depressed counterparts.
Level of Evidence
III, prognostic comparative trial.
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Article info
Publication history
Published online: May 09, 2022
Accepted:
April 19,
2022
Received:
December 29,
2020
See commentary on page 2873Footnotes
The authors report the following potential conflicts of interest or sources of funding: J.B. reports personal fees from Clinical Orthopaedics and Related Research, DJ Orthopaedics, JBJS-American, Nextremity Solutions, Stryker, and Wright Medical Technology, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
