Depression increases the risk of rotator cuff tear and rotator cuff repair surgery: A nationwide population-based study

Abstract

BackgroundChronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression.MethodsThis retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000–2013) between these two cohorts.ResultsThis study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36–1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04–2.06).ConclusionThe present study showed that depression was associated with an ncreased risk of rotator cuff tear and rotator cuff repair surgery.

Effects of preexisting depression and anxiety on postoperative outcomes following arthroscopic rotator cuff repair

“…Similar to a study recently published by Kuo et al, patients with DA in this study had a higher preoperative comorbidity burden including higher rates of diabetes, obesity, coronary artery disease, asthma, and hypertension. 13 Several of these comorbidities, including diabetes, hypertension, and smoking, have been identified as placing patients at a higher risk of symptomatic rotator cuff tear and increased complications following RCR. 2 , 8 , 28 , 29 While postoperative outcome measures were worse in patients with DA when compared to those without DA, both groups showed significant improvement from the first to the last measurement in both pain score and UEFS, with a high percentage of patients reaching the MCID for both measures; there were no differences in the rate of patients achieving MCID between groups.…”

“…17 Psychiatric comorbidities, particularly anxiety and depression, have been associated with poorer outcomes in patients undergoing a wide variety of orthopedic procedures including joint replacement, spine surgery, and sports medicine procedures. 1 , 3 , 13 , 24 When looking specifically at patients undergoing rotator cuff repair (RCR), rates of anxiety and depression as high as 25% of the patients undergoing this procedure have been reported. 5 , 6 The presence of mental illness in patients undergoing RCR has been shown to increase the cost of care both to the patient and the health system and this is a concern with the increased focus on value-based care.…”

“… 1 , 7 Patients with anxiety and depression who undergo RCR have also been shown to have increased risk of postoperative complications, persistent pain, and decreased functional scores. 13 , 14 , 18 …”

Measurement of Upper Extremity–Specific Comfort and Capability

“…19 People with comorbid major depression are more likely to be diagnosed with rotator cuff tendinopathy and receive surgery. 20 In another population-based study, five of six people aged 65 years or older had radiographic evidence of knee osteoarthritis. A threshold level of discomfort and incapability had similar associations with (1) a threshold level of symptoms of depression, and (2) a threshold radiographic severity.…”

Hydrogel Development for Rotator Cuff Repair

“…Acute inflammation is the natural response in the early state of rotator cuff injury, while chronic inflammation is a major cause of rotator cuff quality deterioration, non-healing, or re-tearing after repair. Inhibiting chronic inflammation is an effective means to improve rotator cuff quality, promote healing, and prevent retear after surgical repair ( Childress et al, 2013 ; Kuo et al, 1932 ). The hydrogel itself, such as HA or methacrylated collagen hydrogel or its therapeutic cargo, such as farnesol and curcumin, can be used to inhibit chronic inflammation after rotator cuff repair.…”