Depression Is Associated With Recurrent Instability and Inferior Outcomes After Shoulder Stabilization Surgery

Depression is prevalent among patients undergoing arthroscopic shoulder procedures and is associated with worse patient-reported outcomes after shoulder stabilization surgery. However, recurrent shoulder instability after stabilization among patients with depression has yet to be investigated.

Patients with depression experience higher rates of recurrent shoulder instability and inferior functional outcomes compared with patients without depression.

Cohort study; Level of evidence, 3.

This single-institution retrospective study (2009-2023) identified 531 patients undergoing primary shoulder stabilization surgery for recurrent shoulder instability. Patients were stratified into 2 cohorts based on depression status. Primary procedures included arthroscopic or open Bankart repair, remplissage, open Latarjet, and open distal tibial allograft. Data from electronic medical records included demographics and clinical outcomes.

Of 531 patients, 110 (21%) had a preoperative diagnosis of depression. Compared to patients without a diagnosis of depression, depression patients were older (29.9 vs 24.2 years; P < .001), had higher body mass index (28.5 vs 26.6; P = .005), and greater comorbidities (American Society of Anesthesiologists and Charlson Comorbidity Index scores, smoking rates, and rates of comorbid mental health disorders) (all P < .001). The depression cohort had lower range of motion (ROM) in all measures before surgery, and ROM in external rotation remained lower postoperatively (P < .001). Patients with depression had worse postoperative Single Assessment Numeric Evaluation (82 vs 88; P > .04) and American Shoulder and Elbow Surgeons (79 vs 89; P = .02) scores. Lifetime recurrent instability rates were higher in the depression group compared with the nondepression group (23% vs 14%; P = .03), and instability-free survival at 2, 5, and 10 years was lower in patients with depression (P = .02).

Patients with depression have increased rates of recurrent instability and lower patient-reported outcome scores after shoulder stabilization surgery. Shoulder stabilization surgery is an effective treatment option for patients with depression, but depression evaluation should be considered in the preoperative assessment to aid in patient and physician education on the risks of inferior clinical outcomes.