Association of Mental Health Disorders with Outcomes after Achilles Tendon Repair: A Propensity-Matched Cohort Study

Mental health disorders are increasingly acknowledged as significant factors influencing surgical outcomes. However, their effect on recovery after Achilles tendon repair (ATR) remains inadequately defined. Psychosocial elements may modify pain perception, opioid consumption, adherence to rehabilitation protocols, and overall utilization of health care services.

To evaluate the postoperative complications among patients with preexisting mental health diagnoses in the context of ATR.

Cohort study; Level of evidence, 3.

A retrospective analysis was performed using the TriNetX Research Network on August 14, 2025. Patients with a mental health disorder diagnosis within 1 year before ATR were identified using the International Classification of Diseases, Tenth Revision, and Current Procedural Terminology codes. These patients were compared with controls without a documented diagnosis of mental health disorders. Propensity score matching (1:1) was performed for age, sex, body mass index, and other important comorbidities. The initial search identified 11,787 patients who underwent ATR. Outcomes at 3, 6, 12, and 24 months included ankle pain, stiffness, complex regional pain syndrome (CRPS), wound complications, opioid use, and revision repair. Odds ratios (OR) with 95% CIs were calculated.

After matching, 1767 patients were included in each group. At 3 months, the mental health cohort had 1.59 times higher odds of wound complications (7.2% vs 4.6% [95% CI, 1.19-2.1]; P = .01), 1.39 of ankle stiffness (5.2 vs 3.8% [95% CI, 1.01-1.92]; P = .04), and 1.56 of ankle pain (22 vs 15% [95% CI, 1.32-1.86]; P < .001) compared with the control group. Additionally, the mental health group had higher incidence of emergency department visits (OR, 1.50 [95% CI, 1.19-1.9]; P = .001), reoperation for any reason (OR, 1.51 [95% CI, 1.15-1.99]; P = .003), readmission (OR, 1.76 [95% CI, 1.24-2.50]; P = .001), and opioid use (OR, 1.58 [95% CI, 1.37-1.81]; P < .001). At 6 months, all these differences persisted (all P < .05). At 1 year, ankle pain (12.4% vs 9.3%) and opioid use (22.8% vs 16.4%) remained significantly elevated in the mental health cohort. At 2 years, ankle pain, opioid use, and CRPS (1.4% vs 0.6%; OR, 2.52 [95% CI, 1.20-5.26]; P = .01) were significantly more common. Revision rates did not differ between groups at any time point.

Our study showed that mental health disorders are associated with an increase in postoperative complications after ATR. The persistence of pain and opioid dependence over 2 years underscores the significant long-term impact of psychosocial factors on the recovery process. These findings support the incorporation of routine psychosocial screening and perioperative mental health support into comprehensive care strategies to reduce complications and enhance functional outcomes.