Summary

Patients with an underlying mental health condition that suffer from recurrent patellar dislocations requiring MPFL reconstruction are at risk for worse pre- and post-operative PROMIS scores and not being able to derive the full benefits of surgery.

Abstract

Introduction

Medial patellofemoral ligament (MPFL) reconstruction is commonly performed in patients with recurrent patellar dislocations and instability. There remains limited information on the effects of mental health conditions on baseline and post-operative outcome measures. The purpose of this study is to assess how mental health disorders such as Major Depressive Disorder (MDD) or unrecognized depression can affect outcomes in patients undergoing MPFL reconstruction.

Methods

A retrospective, IRB approved review of patients undergoing MPFL reconstruction from 2015 to 2023 was performed. Demographic data, presence of diagnosed mental health disorders, complications, and Patient Reported Outcomes Measurement Information Systems (PROMIS) scores related to their procedure were collected. Exclusion criteria included patients aged < 10 or >75 years, or those with incomplete PROMIS data. Patients without a formal diagnosis of MDD, but with a pre-op PROMIS-Dep score greater than or equal to 52.5 were considered PROMIS-Depressed. Kruskal-Wallis and chi-squared tests were used to compare continuous and categorical cohort descriptive statistics respectively. Logistic and mixed-effects regression were used to investigate the association between PROMIS T-scores and mental health disorders while adjusting for confounding patient and surgical variables.

Results

187 patients met inclusion criteria. Overall average age 20.4, range 12-63. Average time of final follow was 603 days. 77 patients had a formal diagnosis of a mental health disorder. There were no significant differences in demographic variables. Patients with underlying mental health disorders were more likely to have an underlying connective tissue disease, require longer follow up (512 vs 713 days, p <.05) and had statistically significant worse pre- (PF 41.49 vs 38.16, p <.01, PI 54.6 vs. 58.3, p < .05, Dep 43.4 vs 48.9, p <.01) and post-operative (PF 48.3 vs 44.5 p<.01, PI 46.9 vs 53.5 p<.05, Dep 42.1 vs 45.9 p < .05) PROMIS scores. PROMIS-Depressed patients reported significantly worse pre-and post-operative PROMIS scores compared to patients with no mental health diagnosis and MDD. There were no differences in the change in PROMIS scores after surgery, nor was there a difference in odds of achieving MCID for patients with MDD or who were PROMIS-Depressed. Regression analysis showed an associated between MDD or need for additional procedures and worse average PROMIS Scores in all domains. In addition, the odds of a reported complication or need to have a contralateral procedure were high in patients requiring TTO. Partial correlation of the odds of needing MPFL on the contralateral extremity weakly correlated with lower odds of PROMIS-PI MCID achievement.

Conclusion

Underlying mental health disorders may lead to worse pre- and post-operative PROMIS scores and prevented patients from deriving more improvement from their surgery. This finding was exacerbated in patients who were PROMIS-Depressed. Overall, our cohort improved with surgery, but both diagnosed and undiagnosed MDD adversely affects patients who undergo MPFL reconstruction. These findings highlight the importance of identifying and addressing mental health in this patient population.