New-onset anxiety and depression after anterior cruciate ligament reconstruction: A national database study of incidence, risk-factors, and outcomes.

BACKGROUND: Prior studies evaluating the mental-health burden of recovery from anterior cruciate ligament reconstruction (ACLR) have focused primarily on athletes. The purpose of this study is to evaluate rates of new-onset anxiety and depression (NOAD) after ACLR and identify risk factors in the broad population of ACLR patients. METHODS: A retrospective review of the PearlDiver national database was performed. All patients included had no prior diagnosis of depression or anxiety prior to undergoing ACLR and had ≥1-year follow-up. The primary outcome was development of NOAD within 1-year postoperatively. Multivariate regression was used to assess predictors of NOAD; clinical outcomes were compared between patients with and without NOAD. RESULTS: Of the 20,442 ACLR patients included, 1,284 (6.3%) were diagnosed with NOAD within 1-year postoperatively. Men (OR: 0.63, p < 0.001) and patients from the southern US (OR: 0.81, p = 0.007) had lower rates of NOAD. Conversely, older patients (OR: 1.02, p < 0.001), patients with alcohol disorders (OR: 2.19, p < 0.001), anemia (OR: 1.26, p = 0.008), headaches/migraines (OR: 1.60, p < 0.001), obesity (OR: 1.38; p < 0.001), sleep apnea (OR: 1.40, p < 0.001), tobacco use (OR: 2.15, p < 0.001), and preoperative opioid use (OR: 1.23, p = 0.001) had higher rates of NOAD. Postoperatively, patients with NOAD had higher rates of 90-day readmission (1.1% vs. 0.3%; p < 0.001), higher rates of opioid use at 1-year (30.7% vs. 20.4%; p < 0.001), and higher rates of additional knee surgery at 2-years (5.4% vs. 3.2%; p < 0.001). CONCLUSION: The current study highlights risk factors for NOAD after ACLR that may be used to identify at-risk populations. The development of targeted multidisciplinary interventions may improve outcomes for these patients.