Preoperative Risk Factors for Opioid Use Predict Self-Reported Health and Function Up to 6 Months After Anterior Cruciate Ligament Reconstruction.

Abstract

Purpose: To identify risk factors that predict the need for rescue opioid use and patient-reported outcomes following an opioid-limiting postoperative analgesia protocol after anterior cruciate ligament reconstruction.

Methods: This prospective cohort study recruited 44 patients undergoing primary arthroscopic-assisted anterior cruciate ligament reconstruction. Preoperatively, patients completed questionnaires including demographics, medical history, Visual Analog Scale (VAS), Brief Resilience Scale, Six-Item State-Trait Anxiety Inventory, Patient Health Questionnaire-2, Single Assessment Numeric Evaluation score, and patient-reported outcome measures (PROMs) including Patient-Reported Outcomes Measurement Information System physical component. Postoperatively, patients received acetaminophen, meloxicam, tramadol, gabapentin, and oxycodone. Morphine milligram equivalents (MMEs) and VAS were assessed at multiple timepoints through 6 months. PROMs were completed at 3 and 6 months. Patients were analyzed as a single group and partitioned by Brief Resilience Scale and Six-Item State-Trait Anxiety Inventory scores into low-normal (1.00-4.30) and high (4.31-5.00) resilience, and low (20-37) and moderate-high (38-80) anxiety groups, respectively.

Results: Prior opioid use positively predicted VAS and MME at 48 to 72 hours and MME at 6 weeks. Body mass index positively predicted MME at 2 weeks. Surgical history negatively predicted VAS at 48 to 72 hours, but positively predicted change in Single Assessment Numeric Evaluation score at 3 and 6 months and Patient-Reported Outcomes Measurement Information System physical component score at 6 months.

Conclusions: Only 4.8% of patients required opioid medications more than 2 weeks postoperatively. Patients with prior opioid use exhibited greater postoperative pain and narcotic consumption. Higher body mass index linked to increased opioid use at 2 weeks, whereas individuals with prior surgical history reported less pain and improved PROMs postoperatively. Measurements of patient resilience and anxiety show little effect on postoperative pain, opioid consumption, and PROMs requiring further study.

Level of evidence: Level III, retrospective prognostic case series.