Garcia Grant H, Wu Hao-Hua, Park Min Jung, Tjoumakaris Fotios P, Tucker Bradford S, Kelly John D, Sennett Brian J
The Hospital for Special Surgery, New York, New York, USA.
Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
Am J Sports Med. 2016 Mar;44(3):572-9. doi: 10.1177/0363546515612466. Epub 2015 Dec 1.
Recent literature has recognized a correlation with depression and poor self-reported functional outcome after orthopaedic procedures. However, the effect of depression on anterior cruciate ligament reconstruction (ACLR) outcome has never been studied.
To quantify the incidence of major depressive disorder (MDD) and correlate depression symptoms with patient-rated knee function in patients undergoing ACLR.
Cohort study; Level of evidence, 2.
In this multicenter prospective cohort study, 64 consecutive adult patients undergoing primary ACLR were given the 16-item self-report Quick Inventory of Depressive Symptomatology (QIDS) to assess MDD symptoms preoperatively and at 6 weeks, 12 weeks, 24 weeks, and 1 year postoperatively. Lysholm and International Knee Documentation Committee (IKDC) subjective scores were obtained at the same time points to assess self-reported knee function. A QIDS score ≥6 served as a validated threshold for diagnosis of MDD. MDD and non-MDD group assignment was based on preoperative QIDS score. Student t test analysis was performed to compare ACLR outcomes between MDD and non-MDD patients. Correlation among QIDS, Lysholm, and IKDC scores was determined with Spearman r value.
A total of 27 patients (42%) were categorized in the MDD group. At baseline, the MDD group reported mean Lysholm (50.8) and IKDC (43.7) scores that were significantly lower than those (64.9 and 57.0, respectively) reported by the non-MDD group (P < .05). Both cohorts showed similar and significant absolute improvement from baseline to 1 year postoperatively (MDD vs non-MDD, increase in mean Lysholm: +24.4 vs +23.5 [P = .63]; MDD vs non-MDD, increase in mean IKDC: +28.1 vs +32.3 [P = .21]). While Lysholm and IKDC scores improved in both groups, at 1-year follow-up, MDD patients reported significantly lower mean Lysholm (75.2 vs 88.4; P = .04) and mean IKDC (71.8 vs 89.3; P = .001) scores as compared with their non-MDD counterparts. In addition, a moderate inverse correlation was found between QIDS and Lysholm scores (r = -0.50) and between QIDS and IKDC scores (r = -0.54). Interestingly, 4 patients experienced complications in the MDD cohort (15%), while there were no complications in the non-MDD group.
This study suggests that ACLR may be an equally effective intervention for MDD and non-MDD patients, given their similar significant absolute improvements in functional scores from baseline to 1 year after ACLR. However, MDD patients still reported significantly lower self-reported functional scores at baseline and 1 year postoperatively.
近期文献已认识到骨科手术后抑郁症与自我报告的功能预后不良之间存在关联。然而，抑郁症对前交叉韧带重建（ACLR）预后的影响从未被研究过。
量化接受ACLR患者中重度抑郁症（MDD）的发病率，并将抑郁症状与患者自评膝关节功能相关联。
队列研究；证据等级，2级。
在这项多中心前瞻性队列研究中，连续64例接受初次ACLR的成年患者在术前、术后6周、12周、24周和1年接受16项自评抑郁症状快速量表（QIDS）以评估MDD症状。同时在相同时间点获得Lysholm和国际膝关节文献委员会（IKDC）主观评分以评估自我报告的膝关节功能。QIDS评分≥6作为诊断MDD的有效阈值。MDD组和非MDD组的划分基于术前QIDS评分。进行Student t检验分析以比较MDD和非MDD患者的ACLR预后。用Spearman r值确定QIDS、Lysholm和IKDC评分之间的相关性。
共有27例患者（42%）被归入MDD组。在基线时，MDD组报告的平均Lysholm评分（50.8）和IKDC评分（43.7）显著低于非MDD组报告的评分（分别为64.9和57.0）（P <.05）。两个队列从基线到术后1年均显示出相似且显著的绝对改善（MDD组与非MDD组，平均Lysholm评分增加：+24.4对+23.5 [P =.63]；MDD组与非MDD组，平均IKDC评分增加：+28.1对+32.3 [P =.21]）。虽然两组的Lysholm和IKDC评分均有所改善，但在1年随访时，MDD患者报告的平均Lysholm评分（75.2对88.4；P =.04）和平均IKDC评分（71.8对89.3；P =.001）显著低于非MDD患者。此外，发现QIDS与Lysholm评分之间存在中度负相关（r = -0.50），QIDS与IKDC评分之间也存在中度负相关（r = -0.54）。有趣的是，MDD队列中有4例患者出现并发症（15%），而非MDD组无并发症。
本研究表明，鉴于ACLR术后从基线到1年功能评分有相似的显著绝对改善，ACLR对MDD和非MDD患者可能是同样有效的干预措施。然而，MDD患者在基线和术后1年自我报告的功能评分仍显著较低。
