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. 2025 Mar 17:70:63-69.
doi: 10.1016/j.jor.2025.03.006. eCollection 2025 Dec.

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

Joshua P Castle  1 , Michael A Gaudiani  1 , Muhammad J Abbas  1 , Eleftherios L Halkias  2 , Brittaney A Pratt  1 , Matthew A Gasparro  1 , Susan G Wager  2 , Vasilios Moutzouros  1 , Eric C Makhni  1
Affiliations

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

Joshua P Castle et al. 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.

Keywords: ACL reconstruction; Arthroscopic ACL reconstruction; Mental health; PHQ2; Patient-reported outcomes; Screening tools.

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Conflict of interest statement

Joshua P. Castle, Michael Gaudiani, Muhammad Abbas, Eleftherios L. Halkias, Brittaney Pratt, Matthew A. Gasparro, Susan G. Wager, Vasilios MoutzourosThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Eric C. Makhni The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Eric C. Makhni reports a relationship with American Academy of Orthopaedic Surgeons that includes: board membership. Eric C. Makhni reports a relationship with American Orthopaedic Society for Sports Medicine that includes: board membership. Eric C. Makhni reports a relationship with Arthroscopy Journal that includes: board membership. Eric C. Makhni reports a relationship with Protera Health that includes: equity or stocks. Eric C. Makhni reports a relationship with Springer that includes: consulting or advisory.

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