Diagnosed Mental Health Disorders Are Associated With Greater Rates of Postoperative Complications, Additional Procedures, and Lower Anterior Cruciate Ligament Tears and Revision Rates After Anterior Cruciate Ligament Reconstruction.

PURPOSE: To analyze the influence of diagnosed mental disorders on postoperative outcomes after arthroscopic anterior cruciate ligament (ACL) reconstruction.

METHODS

Using the TriNetX health network database, we evaluated postoperative complications and additional procedures of patients who underwent arthroscopic ACL reconstruction over a 20-year period. Patients with a documented mental health disorder (e.g., anxiety or depression) within 1 year preceding surgery were compared with patients without mental health disorders. The cohorts were propensity-matched for demographic and medical factors, including hypertension, type 2 diabetes, and obesity. Short- and long-term outcomes were evaluated within 90 days and 3 years postoperative, respectively. A χ2 analysis was performed to compare outcomes between the 2 cohorts.

RESULTS

A total of 8,351 patients with diagnosed mental health disorders were propensity-score matched at a 1:1 ratio with 82,127 patients without diagnosed mental health disorders. Within 90 days postoperative, patients with diagnosed mental health disorders demonstrated significantly greater odds of postoperative infection (P = .0042), lower limb mononeuropathy (P = .025), acute postoperative pain (P < .0001), knee stiffness (P < .0001), and any emergency department visit (P <.0001). Within 3 years postoperative, these patients had significantly greater odds of opioid abuse (P = .0015), knee pain (P < .0001), patella fracture (P =.0008), and arthrocentesis/aspiration/injection (P = .0005) but significantly lower odds of ACL tear (P < .0001) and repeat ACL reconstruction (P = .0033).

CONCLUSIONS

Diagnosed mental health disorders were associated with increased short- and long-term postoperative complications after ACL reconstruction but also demonstrated a potentially protective association with multiple postoperative outcomes, including decreased odds of additional ACL tears and reconstructions.

LEVEL OF EVIDENCE: Level III, retrospective, comparative cohort study.