Opioid Overprescription After Knee Arthroscopy and Related Surgery in Adolescents and Young Adults

Resolution of Pain and Predictors of Postoperative Opioid use after Bridge-Enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction

“…We demonstrated that patients with a greater BMI and those that had more pain in their injured knee preoperatively (indicated by a lower preoperative KOOS pain score) took more opioid medication postoperatively. This is consistent with Tepolt et al, 33 who showed via multivariate analysis that a patient's weight was predictive of postoperative opioid consumption. It has also been shown previously that filling opioid prescriptions preoperatively increased demand for postoperative opioid use after ACL reconstruction.…”

“…31,32 There is limited evidence in the previous literature detailing opioid consumption patterns in patients undergoing an ACL reconstruction or related procedure, likely largely due to its outpatient nature and subsequent difficulty with accurate follow-up. Tepolt et al 33 were able obtain a 60% follow-up rate when using patient-reported medication logbooks and found that for those undergoing any ACL procedure, the mean number of opioid pills (1 pill ¼ 5 mg oxycodone ¼ 7.5 mg MED) consumed was 20.6 AE 13.3 (range 0-69). This equates to a 155 AE 100mg MED, similar to the 187.2 mg MED seen in the subjects treated with bridge-enhanced ACL repair and the 138.3 mg MED seen in the subjects undergoing ACL reconstruction.…”

“…This was consistent with a recently published study that reported a 68% unused opioid rate in adolescents and young adults undergoing knee arthroscopy and related procedures. 33 Kim et al 40 evaluated opioid use after upperextremity surgical procedures and found a 66% unused rate. Sabatino et al 6 looked at adult patients undergoing 5 common elective orthopedic procedures (total hip arthroplasty, total knee arthroplasty, endoscopic carpal tunnel release, arthroscopic rotator cuff repair and lumbar decompression) and demonstrated that 61% of patients had excess opioid medication remaining, accounting to 43,216 unused pills.…”

Opioids After Arthroscopy: We're Only Halfway Through the Crisis

“…In an accompanying Editorial Commentary, 21 Westermann suggested that cessation of opioid use before surgery "should be given strong consideration" because of "opioid-induced hyperalgesia (where opioid medications can make pain worse and not better)." In a group of 100 adolescent and young patients, Tepolt et al 22 found a major problem of opioid overprescribing: patients having knee arthroscopy, anterior cruciate ligament reconstruction, or osteotomy used, on average, only 32% of the opioid pills prescribed; 11% of patients used no prescribed opioids; and only 1% requested a refill. Finally, in a prospective study of arthroscopic partial meniscectomy patients, Pham et al 23 compared patients who were prescribed opioids alone with patients prescribed a combination of nonsteroidal anti-inflammatory drugs plus at least onethird less opioids and showed "no significant difference in pain control, satisfaction, and total 1-week opioid use," confirming that "we are currently overprescribing opioids after arthroscopic partial meniscectomy."…”

Editorial Commentary: Unraveling Gordian's Knot: Opioids in Arthroscopy Pain Management

“…Tepolt, Bido, Burgess, Micheli and Kocher, 3 in their article entitled "Opioid Overprescription After Knee Arthroscopy and Related Surgery in Adolescents and Young Adults," conclude that "Following knee arthroscopy and related surgery, including ligament reconstruction or tibial tubercle osteotomy, adolescent and young adult patients are commonly overprescribed opioids, consuming on average only approximately one-third of those prescribed. "…”