Impact of Depression on Rehabilitation Outcomes in Pediatric Patients Undergoing ACL Reconstruction: A Retrospective...

Depression in pediatric populations is rising rapidly and may adversely impact recovery from orthopaedic procedures such as anterior cruciate ligament (ACL) reconstruction. Although the psychological consequences of musculoskeletal injuries have been explored in adults, there remains a gap in understanding how depression affects postoperative outcomes in pediatric ACL patients.

This study aimed to evaluate whether depression is associated with differences in postoperative outcomes - including pain, physical function, medication use, and reoperation rates - among pediatric patients undergoing ACL reconstruction.

A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Pediatric patients (18 ​​​​​​years or younger) who underwent arthroscopically assisted ACL reconstruction were divided into 2 cohorts: those with a diagnosis of depression before surgery (ACL + Depression) and those without (ACL - Depression). Propensity score matching was used to control for race and sex. Outcomes assessed during the 6-month postoperative period included pain in the knee, joint stiffness, effusion, gait abnormalities, opioid and nonopioid analgesic use, physical therapy visits, and subsequent ACL reconstruction. Risk ratios, 95% confidence intervals, and P values were calculated.

After matching, 354 patients were included in each cohort. The ACL + depression group had significantly higher use of nonopioid (21.5% vs. 12.4%, P=0.001) and opioid analgesics (21.8% vs. 13.6%, P=0.004), and higher rates of joint stiffness (17.2% vs. 11.9%, P=0.043) and knee effusion (14.1% vs. 7.6%, P=0.005). Rates of reported knee pain were similar between groups (39.5% vs. 34.5%, P=0.161). A trend toward increased gait abnormalities was observed in the depression group (8.8% vs. 5.1%, P=0.088). Subsequent ACL reconstructions occurred in 2.8% of the ACL + depression group and 0% of the nondepressed group (P=0.001).

Depression is associated with increased medication use, physical recovery challenges, and higher reoperation rates in pediatric patients following ACL reconstruction, despite similar rates of reported pain. These findings emphasize the need for integrated physical and mental health care during the postoperative period. A multidisciplinary approach - including early mental health screening and support - may improve outcomes in this vulnerable population.