Diagnosed Mental Health Disorders Are Associated With Greater Rates of Postoperative Complications, Additional Procedures, and Lower Anterior Cruciate Ligament Tears and Revision Rates After Anterior Cruciate Ligament Reconstruction

Purpose: To analyze the influence of diagnosed mental disorders on postoperative outcomes after arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods: Using the TriNetX health network database, we evaluated postoperative complications and additional procedures of patients who underwent arthroscopic ACL reconstruction over a 20-year period. Patients with a documented mental health disorder (e.g., anxiety or depression) within 1 year preceding surgery were compared with patients without mental health disorders. The cohorts were propensity-matched for demographic and medical factors, including hypertension, type 2 diabetes, and obesity. Short- and long-term outcomes were evaluated within 90 days and 3 years postoperative, respectively. A χ² analysis was performed to compare outcomes between the 2 cohorts. Results: A total of 8,351 patients with diagnosed mental health disorders were propensity-score matched at a 1:1 ratio with 82,127 patients without diagnosed mental health disorders. Within 90 days postoperative, patients with diagnosed mental health disorders demonstrated significantly greater odds of postoperative infection (P = .0042), lower limb mononeuropathy (P = .025), acute postoperative pain (P < .0001), knee stiffness (P < .0001), and any emergency department visit (P <.0001). Within 3 years postoperative, these patients had significantly greater odds of opioid abuse (P = .0015), knee pain (P < .0001), patella fracture (P =.0008), and arthrocentesis/aspiration/injection (P = .0005) but significantly lower odds of ACL tear (P < .0001) and repeat ACL reconstruction (P = .0033). Conclusions: Diagnosed mental health disorders were associated with increased short- and long-term postoperative complications after ACL reconstruction but also demonstrated a potentially protective association with multiple postoperative outcomes, including decreased odds of additional ACL tears and reconstructions. Level of Evidence: Level III, retrospective, comparative cohort study.