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Updated: Sep 17, 2025
Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Diagnosed Mental Health Disorders Are Associated With Greater Rates of Postoperative Complications, Additional
Ahad Kesaria1, Brady P Moore2, Oluwatofe Alimi3
1John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas, U.S.A..
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.
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