Preoperative Opioid Use Predicts Prolonged Postoperative Opioid Use and Inferior Patient Outcomes Following Anterior Cruciate Ligament Reconstruction

Purpose: (1) To determine patient factors associated with prolonged opioid use following Anterior Cruciate Ligament Reconstruction (ACLR) and (2) to evaluate the influence of preoperative opioid use on patient reported outcomes.

Methods: Patients who underwent ACLR and used opioids prior to the perioperative period, which was defined as the window 30 days prior to 15 days following the index surgery, were designated as pre-operative opioid users (OU). Patients who used opioids only in the perioperative period or post-operative period were designated as opioid-naïve (N-OU).. Predictors of opioid use at 6 and 12 months post-operatively and associations between preoperative opioid use and patient outcomes were assessed.

Results: After IRB approval, we identified 253 patients (225 N-OU and 28 OU) who underwent ACLR from 2014 to 2018 at a single institution and had one year follow up (median: 11.6 months; IQR: (8.9-14.3)). Patients with a history of preoperative opioid use (OR: 3.63, P=0.034), higher preoperative VAS pain scores (OR: 1.32, 95% CI 1.04-1.67; P=0.003) and higher BMI (OR: 1.09, P=0.018) were significantly more likely to be taking opioids at 6 months postoperatively. Patients with a perioperative opioid intake of greater than 513 oral morphine equivalents were significantly more likely to continue taking opioids at the 6 month (OR: 3.17, P=0.024) and the 1 year (OR: 3.34, P=0.048) postoperative time points. Patients with preoperative opioid use were significantly less likely to achieve the patient acceptable symptomatic state (PASS) on the IKDC, KOOS Sport, KOOS JR, KOOS Pain, KOOS Symptoms, KOOS QoL and KOOS ADL.

Conclusion: Preoperative opioid use, BMI >30 and higher VAS pain scores were predictors of continued opioid use at 6 months postoperatively. Preoperative opioid users were more likely to continue taking opioids, demonstrate significantly worse patient reported outcomes at baseline and 1-year postoperatively, and were less likely to achieve PASS.