Duke Sport Science Institute, Department of Orthopaedics, Duke University Medical Center, North Carolina, USA.
Bassett Healthcare Network, Cooperstown, New York, USA.
Am J Sports Med. 2019 Nov;47(13):3073-3079. doi: 10.1177/0363546519876914. Epub 2019 Oct 4.
Few studies have considered the potential effect of depression or anxiety on outcomes after rotator cuff repair.
To evaluate the effect of a preexisting diagnosis of depression or anxiety, as well as the feeling of depression and anxiety directly related to the shoulder, on the American Shoulder and Elbow Surgeons (ASES) score.
Cohort study; Level of evidence, 3.
This study is a retrospective review of prospectively collected data on patients who underwent arthroscopic rotator cuff repair and were evaluated by the ASES score preoperatively and at a minimum 12 months postoperatively as part of the senior author's shoulder registry. Preexisting diagnoses of depression and/or anxiety were recorded, and questions from the Western Ontario Rotator Cuff Index directed at feelings of depression or anxiety related to the shoulder were also evaluated. The Wilcoxon rank sum test was used to compare ASES scores between patients with and without anxiety and/or depression. Spearman correlation was used to correlate questions on depression and anxiety with ASES scores.
A total of 187 patients (63 females, 124 males; mean age, 58.6 years, SD, 8.7 years) undergoing arthroscopic rotator cuff repair were evaluated with a mean follow-up of 47.5 months (SD, 17.4 months; range, 12-77 months). Fifty-three patients (mean age, 60 years; SD, 8.6 years) had preexisting diagnoses of depression and/or anxiety and 134 patients (mean age, 58.1 years; SD, 8.7 years) did not. Patients with depression and/or anxiety had significantly lower preoperative and postoperative ASES scores (60.7 vs 67.8, = .014; and 74.6 vs 87.1, = .008, respectively). The change in ASES scores from preoperative to postoperative, however, was not significantly different (18.0 vs 14.9). A higher score of depression or anxiety related to the shoulder had a negative correlation with the preoperative ( = -0.76, < .0001; and = -0.732, < .0001, respectively) and postoperative ( = -0.31, = .0001; and = -0.31, = .0003, respectively) ASES scores, but a positive correlation ( = 0.50, < .0001; and = 0.43, < .0001, respectively) with the change in ASES scores.
Patients with a history of depression and/or anxiety have lower outcome scores preoperatively and postoperatively; however, they should expect the same amount of relief from arthroscopic rotator cuff repair as those without a history of depression or anxiety. Stronger feelings of depression or anxiety directly related to the shoulder correlated with lower preoperative and postoperative outcome scores, but a greater amount of improvement from surgery. The results from this study suggest that a preexisting diagnosis of depression or anxiety, as well as feelings of depression or anxiety directly related to the shoulder, should be considered during the management of patients with rotator cuff tears.
很少有研究考虑抑郁或焦虑对肩袖修复后结果的潜在影响。
评估术前存在的抑郁或焦虑诊断以及与肩部直接相关的抑郁和焦虑感对美国肩肘外科医生（ASES）评分的影响。
队列研究；证据水平，3 级。
本研究是对前瞻性收集的接受关节镜肩袖修复患者数据的回顾性分析，这些患者在接受高级作者的肩部登记处的 ASES 评分时进行了术前和至少 12 个月的术后评估。记录了术前的抑郁和/或焦虑诊断，并评估了 Western Ontario Rotator Cuff Index 中针对与肩部相关的抑郁或焦虑感的问题。使用 Wilcoxon 秩和检验比较有焦虑和/或抑郁的患者与无焦虑和/或抑郁的患者的 ASES 评分。使用 Spearman 相关分析评估与 ASES 评分相关的抑郁和焦虑问题。
共评估了 187 名接受关节镜肩袖修复的患者（63 名女性，124 名男性；平均年龄 58.6 岁，标准差 8.7 岁），平均随访时间为 47.5 个月（标准差 17.4 个月；范围 12-77 个月）。53 名患者（平均年龄 60 岁；标准差 8.6 岁）存在抑郁和/或焦虑的既往诊断，而 134 名患者（平均年龄 58.1 岁；标准差 8.7 岁）不存在。患有抑郁和/或焦虑症的患者术前和术后 ASES 评分明显较低（分别为 60.7 分和 67.8 分， =.014；74.6 分和 87.1 分， =.008）。然而，从术前到术后的 ASES 评分变化无显著差异（18.0 分和 14.9 分）。与肩部相关的更高程度的抑郁或焦虑评分与术前（ = -0.76，<.0001；和 = -0.732，<.0001）和术后（ = -0.31， =.0001；和 = -0.31， =.0003）的 ASES 评分呈负相关，但与 ASES 评分的变化呈正相关（ = 0.50，<.0001；和 = 0.43，<.0001）。
有抑郁和/或焦虑史的患者术前和术后的结果评分较低；然而，他们应该期待关节镜肩袖修复能像没有抑郁或焦虑史的患者一样获得同样的缓解。与肩部直接相关的更强的抑郁或焦虑感与术前和术后的结果评分较低相关，但手术的改善程度更大。这项研究的结果表明，在管理肩袖撕裂患者时，应考虑到术前存在的抑郁或焦虑诊断以及与肩部直接相关的抑郁或焦虑感。
