The effect of comorbid anxiety and major depression on functional outcomes in meniscectomy

Introduction: Psychiatric disorders such as depression and anxiety are prevalent but often unrecognized in orthopedic settings. While psychiatric conditions are known to affect functional outcomes in a variety of orthopedic procedures, limited data exist on their impact after meniscectomy. Objectives: To evaluate the influence of comorbid anxiety and depression on pain and functional outcomes following meniscectomy. Methods: Between August 2016 and January 2018, 141 patients scheduled for arthroscopic meniscectomy were prospectively recruited. Preoperatively, they completed the Computerized Adaptive Testing-Mental Health (CAT-MH) questionnaire, screening for major depressive disorder (MDD), anxiety, and mania. Functional outcome measures (IKDC, KOOS, SF12, VR12, and VR6D) were collected preoperatively and 6 months postoperatively. Outcomes were compared between patients with and without MDD, and symptoms of anxiety and mania were correlated with outcome scores. Results: Of the 141 patients, 120 completed the study. Thirteen patients (10.9%) screened positive for MDD, 10 (76.9%) of whom were female. Women reported lower levels of function on almost all measures. MDD-positive patients reported lower outcomes preoperatively and postoperatively. Higher anxiety levels were linked with lower baseline and postoperative scores. Both MDD-positive and -negative cohorts showed significant improvements in most outcome measures postoperatively. There was no difference in the extent of improvement between groups. Mania had no impact on outcomes. Conclusions: Comorbid anxiety and depression were associated with worse preoperative and postoperative functional outcomes after meniscectomy, though both groups show similar improvement. These findings highlight the need for better mental health screening tools in orthopedics, as psychiatric conditions may disproportionately influence patient-reported outcomes.