Preoperative depression screening using PHQ-2 is associated with worse outcomes after ACL reconstruction

Authors

Joshua P. Castle, Henry Ford HealthFollow
Michael A. Gaudiani, Henry Ford HealthFollow
Muhammad J. Abbas, Henry Ford HealthFollow
Eleftherios L. Halkias, Henry Ford HealthFollow
Brittaney A. Pratt, Henry Ford HealthFollow
Matthew A. Gasparro, Henry Ford HealthFollow
Susan Wager, Henry Ford HealthFollow
Vasilios Moutzouros, Henry Ford HealthFollow
Eric C. Makhni, Henry Ford HealthFollow

Recommended Citation

Castle JP, Gaudiani MA, Abbas MJ, Halkias EL, Pratt BA, Gasparro MA, Wager SG, Moutzouros V, and Makhni EC. Preoperative depression screening using PHQ-2 is associated with worse outcomes after ACL reconstruction. J Orthop 2025; 70:63-69.

Document Type

Article

Publication Date

3-17-2025

Publication Title

J Orthop

Abstract

PURPOSE: To determine how screening positive for depression preoperatively can affect patient reported outcomes after anterior cruciate ligament reconstruction (ACLR).

METHODS: Primary ACLR patients between May 2020-September 2022 with a PHQ-2 score prior to their surgery were retrospectively reviewed. Patients older than 13 years of age and with minimum 6-months of follow-up were included for analysis. Patients were categorized as PHQ(+) (PHQ-2 ≥2) or PHQ2(-) (PHQ-2 < 2). Demographics, preoperative and postoperative Patient Reported Outcome Information System (PROMIS) -Physical Function (PF) and Pain Interference (PI) scores, Patient Acceptable Symptomatic State (PASS), surgical clinical outcomes, and complications were collected and compared. Chi-square tests and independent t-tests were used for categorical and continuous variables, respectively.

RESULTS: A total of 127 patients were analyzed, with 32 PHQ2(+) and 95 PHQ2(-). The PHQ2(+) group had a lower proportion responding "yes" to PASS preoperatively (6.5 % vs. 25.3 %, p = 0.03), at 9 months (47.4 % vs. 72.4 %, p = 0.05), and 12 months postoperatively (42.9 % vs 79.5 %, p = 0.009). PHQ2(+) reported worse PROMIS-PI scores preoperatively, at 6 months, and at 9 months. The PHQ2(+) group reported worse PROMIS-PF preoperatively, at 6 months, at and 12 months. The PHQ2(+) group had worse IKDC scores preoperatively at 9 months and at 12 months. Those screening positive for depression also demonstrated a higher incidence of postoperative complications (34.4 % vs. 9.5 %, p = 0.001) and reoperation rates (21.9 % vs. 4.2 %; p = 0.002).

CONCLUSION: A brief preoperative survey, such as the PHQ-2, can provide prognostic value for patient outcomes after ACLR.

LEVEL OF EVIDENCE: III-Retrospective cohort study.

PubMed ID

40225057

Volume

70

First Page

63

Last Page

69