INTRODUCTION/OBJECTIVES: Medial patellofemoral ligament reconstruction (MPFL-R) is commonly performed in patients with recurrent patellar dislocations and associated instability. However, there remains limited information on the effects of underlying mental health conditions such as major depressive disorder (MDD) on operative outcomes. This study assesses how mental health disorders such as MDD or unrecognized depression can affect pre- and post-operative outcomes in patients undergoing MPFL-R. METHODS: A retrospective analysis of patients who underwent MPFL-R from 2015-2023 was performed. Demographic data, presence of diagnosed mental health disorders, and pre- and post-operative Patient Reported Outcomes Measurement Information Systems (PROMIS) scores were collected. Exclusion criteria included patients aged 75 years, or those with incomplete PROMIS data. Patients without a formal diagnosis of MDD, but with a pre-op PROMIS-Depression T-score ≥ 52.5 were considered undiagnosed/PROMIS-Depressed. RESULTS: 187 patients met inclusion criteria. Patients with a mental health disorder were more likely to have an underlying connective tissue disease and require longer follow-up (512 vs 713 days, p <0.05). Presence of a mental health disorder led to significantly worse pre-and post-operative PROMIS Depression, Physical Function, and Pain Interference scores. MDD and PROMIS-depressed patients reported significantly worse pre- and post-operative PROMIS scores, with those who were PROMIS-depressed particularly doing worse compared those without underlying mental health disorders. Odds of achieving Minimal Clinically Important Difference (MCID) were similar across all cohorts. Regression analysis showed an association between underlying mental health disorders or PROMIS-depression with worse average PROMIS scores. CONCLUSION: Patients with underlying mental health disorders may still significantly benefit from MPFL-R compared to their unaffected counterparts but will nonetheless report worse pre- and post-operative PROMIS scores. Overall, our cohort improved with surgery, but both diagnosed and undiagnosed MDD may still adversely affect patients undergoing MPFL-R. These findings highlight the importance of identifying and addressing mental health in this patient population. LEVEL OF EVIDENCE: Level III.
Greif et al. (Sun,) studied this question.