# Impact of preoperative anxiety and depressive symptoms on clinical outcomes of anterior talofibular ligament reconstruction surgery

## TL;DR

This study found that patients with preoperative anxiety or depression had worse initial outcomes after ankle ligament surgery but showed similar improvements in physical recovery and greater mental health improvement over time.

## Contribution

The study quantifies the impact of preoperative anxiety and depression on clinical outcomes and improvement in ATFL surgery.

## Key findings

- Patients with preoperative anxiety/depression had worse initial clinical scores compared to those without.
- Both groups showed similar improvements in pain and function, but mental health scores improved more in the anxiety/depression group.
- Managing preoperative psychological symptoms may enhance surgical outcomes for ATFL repair.

## Abstract

This study aimed to compare the clinical outcomes of patients undergoing anterior talofibular ligament (ATFL) repair with or without preoperative anxiety/depressive symptoms, both preoperatively and at the final follow-up, and to quantify the association between these symptoms and the degree of improvement in surgical efficacy.

A total of 91 patients who underwent ATFL repair at Xi’an Honghui Hospital between January 2015 and August 2023 were included. Baseline characteristics were collected, and assessments were performed using the Hospital Anxiety and Depression Scale (HADS), the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and the Visual Analog Scale (VAS), both preoperatively and at the final follow-up. Patients were divided into two groups based on the presence or absence of preoperative anxiety/depressive symptoms: the Anxiety/Depression group (Group A) and the Non-Anxiety/Depression group (Group B). Baseline characteristics such as gender, age, disease duration, BMI, and follow-up duration were statistically analyzed to ensure comparability between groups. Clinical outcomes and changes in evaluation scores between the two time points were then compared.

A total of 81 patients completed the full follow-up, among whom 40 patients (49.38%) presented with preoperative anxiety/depressive symptoms. At the final follow-up, all patients demonstrated significant improvements in VAS, AOFAS, HADS-A, and HADS-D scores compared to preoperative values (P < 0.001). Further analysis revealed that Group B (without preoperative symptoms) had significantly better VAS, AOFAS, HADS-A, and HADS-D scores both preoperatively and postoperatively than Group A (P < 0.001). However, the improvements in HADS-A and HADS-D scores from preoperative to final follow-up were significantly greater in Group A (P < 0.001), whereas no significant differences were observed between groups in the improvement of VAS and AOFAS scores (P > 0.05).

Patients with preoperative anxiety/depressive symptoms demonstrated worse clinical evaluations both preoperatively and at follow-up compared to those without such symptoms. However, both groups experienced comparable improvements in pain and function, while patients with preoperative psychological symptoms showed greater mental health improvement. These findings suggest that management of preoperative anxiety and depression may improve surgical outcomes in patients undergoing ATFL repair.