Editorial Commentary: Preoperative Mental Health Screening, Early Identification, and Use of Multidisciplinary Patient-Specific Care May Help Improve Postoperative Outcomes in Patients With Mental Health Disorders Undergoing Anterior Cruciate Ligament Reconstruction.

Abstract

Within the field of sports medicine, it is estimated that more than 200,000 anterior cruciate ligament tears occur every year and nearly one half of these patients will undergo anterior cruciate ligament reconstruction (ACLR) surgery. Although ACLR remains the gold standard for treatment and has demonstrated widely successful outcomes over the years, a small percentage of patients will experience postoperative complications such as instability, persistent knee pain, osteoarthritis, graft rupture, infection, and/or knee stiffness that may impact function and quality of life. Despite the overall success of the procedure, a better understanding of the modifiable risk factors for postoperative complications after ACLR is still needed. Specifically, a high percentage of depression and anxiety has been reported after anterior cruciate ligament injury and ACLR, with some studies reporting clinically significant depression in up to 42% of patients. These patient-specific psychological factors can lead to fear of reinjury, low rehabilitation participation, pain catastrophizing, and/or a low internal health locus of control that can negatively impact the postoperative recovery. Although higher-level studies are still warranted to elucidate the underlying mechanisms, recent reports have demonstrated that patients with existing preoperative mental health comorbidities, such as depression and/or anxiety, are at an increased risk for postoperative complications and inferior functional outcomes after ACLR. As such, early identification of at-risk patients using validated mental health screening tools can assist in facilitating multi-disciplinary patient-specific interventions that may improve postoperative optimization, patient-centered care, and ultimately, functional outcomes after ACLR. Overall, it is essential to understand that the mental health status of our patients can greatly influence physical recovery after ACLR, and action toward optimization must be taken in these at-risk patients.