Preoperative Depression Negatively Impacts Pain and Functionality Outcomes Following ACL Reconstruction: A Systematic Review

Abstract

Purpose

To systematically investigate the influence of pre-operative depression diagnosis and symptom severity on outcomes following anterior cruciate ligament reconstruction.

Methods

A literature search was performed using PubMed, Scopus, and EMBASE databases according to the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies evaluating the impact of depression on clinical outcomes following ACL reconstruction were included. Clinical outcomes, changes in depression, and complications were aggregated.

Results

Nine studies comprising 308,531 patients (mean age of 28.1 years; range 14-50 years) were included. Depression incidence ranged from 3.8-42%. Seven studies showed postoperative improvement in depression scores, with five reporting statistical significance.

Assessment of depression exhibited substantial variability, with Patient-Reported Outcomes Measurement Information System (PROMIS) scores being the most common method.

Depressed patients, despite showing greater improvements in scores, experienced significantly higher PROMIS Pain Interference (PROMIS-PI) scores preoperatively (range, 59.1-65.7 vs 56.8-59.2) and postoperatively (range, 46.3-52.3 vs 46.3-47.4) compared to non-depressed patients. They also demonstrated significantly lower preoperative (range, 33-38.1 vs 39.7-41.5) and postoperative (range, 51.6-56.7 vs 56.7-57.6) PROMIS Physical Function (PROMIS-PF) scores, regardless of greater score improvement. Patients affected by depresssion had significantly higher rates of minimal clinically important difference (MCID) achievement for PROMIS-PF (71-100% vs 80%) and similar rates for PROMIS-PI (71-81% vs 68%) than non-depressed patients in three studies. Depression was associated with reduced adherence to rehabilitation protocols and increased postoperative complications, including infections, graft failures, arthrofibrosis, and readmission.

Conclusion

ACL reconstruction yields favorable outcomes for patients with and without preoperative depression. Individuals with preoperative depression may report inferior outcomes in terms of pain and functionality; nevertheless, despite these challenges, they exhibit significant improvements across all outcome measures following surgery, including reductions in depression levels.

Study Design

Systematic review of level II - IV studies; Level of evidence IV