JAAOS - 2026-07-15 - Journal Article
A Comprehensive Analysis of the Preoperative and Postoperative Psychological Health Status of Patients With Achilles Tendon Rupture: Clinical Observation and Efficacy Evaluation.
Gao S, Cao S, Hu D, Lu J, Li Y, Xu J
Topics
Key Takeaway
47.9% of ATR surgical patients had preoperative anxiety/depressive symptoms, and this subgroup demonstrated significantly worse postoperative anxiety and functional outcomes (AOFAS, ATRS) at final follow-up despite equivalent pain improvement.
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Summary
This study stratified 71 open ATR repair patients by preoperative anxiety/depressive symptoms (HADS) into Group A (n=34, 47.9%) and Group B (n=37) and compared HADS, VAS, AOFAS, and ATRS scores pre- and postoperatively. Both groups improved significantly across all metrics after open repair. At final follow-up, Group A retained significantly worse anxiety scores and functional outcomes (AOFAS, ATRS) versus Group B (P<0.05), though pain improvement magnitude did not differ between groups.
Key Limitation
The follow-up duration is unspecified, making it impossible to determine whether the functional and anxiety deficits in Group A are permanent or represent delayed recovery.
Original Abstract
PURPOSE
This study aims to assess the psychological health status of patients with Achilles tendon rupture (ATR) and explore the potential effect of preoperative psychological health on the prognosis of ATR surgical outcomes. By thoroughly analyzing the role of psychological factors in surgical recovery, this study seeks to provide a more comprehensive reference for clinical treatment.
METHODS
This study included 71 patients with ATR who underwent open surgical treatment at the Department of Foot and Ankle Surgery at Xi'an Honghui Hospital from March 2018 to February 2022. Based on the presence of anxiety/depressive symptoms before surgery, patients were divided into two groups: group A, comprising patients with anxiety/depressive symptoms before surgery, and group B, comprising patients without anxiety/depressive symptoms before surgery. Preoperative and final follow-up evaluations were conducted using the Hospital Anxiety and Depression Scale, the Visual Analog Scale (0-100 mm), the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, and the Achilles Tendon Rupture Score. A comparative analysis of the clinical functional outcomes of the two groups was done, and changes in pain symptoms before and after surgery were compared between the two groups.
RESULTS
A total of 71 patients with ATR were included in the study, with 34 patients (47.9%) exhibiting anxiety/depressive symptoms before surgery. After undergoing open surgical repair, both groups showed significant improvements in all evaluation indicators ( P < 0.05). Preoperatively, patients with anxiety/depressive symptoms reported significantly more severe pain compared with those without such symptoms ( P < 0.05); at the final follow-up, no significant differences were observed between the two groups in pain and depressive symptoms ( P > 0.05). However, patients with preoperative anxiety/depressive symptoms demonstrated significantly worse outcomes in anxiety symptoms and functional activities compared with those without such symptoms ( P < 0.05). No significant intergroup differences were detected in pain symptom progression from baseline to final follow-up ( P > 0.05). However, although postoperative pain changes did not differ markedly, patients with preoperative anxiety or depression demonstrated greater recovery challenges, especially in functional outcomes.
CONCLUSIONS
Open surgical repair of ATR markedly improved patients' foot function. However, patients with preoperative anxiety/depressive symptoms experienced more severe pain and a slower functional recovery postoperatively. Although no notable differences were observed in the changes in pain symptoms before and after surgery between the two groups, preoperative psychological health status markedly influenced postoperative functional recovery. Future research should further investigate the use of psychological interventions to enhance postoperative recovery, particularly for patients with anxiety or depressive symptoms before surgery.