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

Abstract

Purpose: To compare postoperative pain scores and opioid use between patients undergoing a standard arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft with those undergoing a suture repair augmented with an extracellular matrix scaffold (bridge-enhanced ACL repair) performed through an arthrotomy and to determine factors predictive of postoperative opioid use and levels of overprescription. Methods: A nonrandomized controlled trial was conducted with 20 patients (10 ACLR, 10 bridge-enhanced ACL repair), aged 18 to 35 years. All surgeries were performed by a single surgeon. A pain medication log was provided to patients on discharge. No regional anesthesia was performed. Pain scores via a visual analog pain scale were recorded at each visit. Correlations between preoperative and intraoperative characteristics and postoperative opioid use were determined. Results: The total morphine-equivalent dose ranged from 30 to 309 mg (4-42 pills oxycodone) for the ACLR group and 75 to 254 mg (10-34 pills oxycodone) for the bridge-enhanced ACL repair group. The average opioid use per day was 35.8 mg for the patients undergoing bridge-enhanced ACL repair and 44.2 mg for patients undergoing ACLR (P ¼ .29). Pain scores at time points up to 2 years postoperatively were not significantly different between the 2 groups. Across both groups, the average oversupply of oxycodone was 46 pills per patient, a greater than 70% unused opiate rate. Preoperative body mass index and preoperative Knee Injury and Osteoarthritis Outcome Scores pain score were predictive of greater postoperative opioid use per day, whereas age, concurrent meniscal repair, and operative time were not. Conclusions: Total overall opiate intake was not different between the patients undergoing bridge-enhanced ACL repair through an arthrotomy and those undergoing arthroscopic ACLR. Both groups had similar pain scores from 2 weeks to 2 years postoperatively.

Bridge enhanced ACL repair vs. ACL reconstruction for ACL tears: A systematic review and meta-analysis of comparative studies

“…ACL tears are a common injury seen in athletes. For a long time, ACLR was the standard of care when faced with such an injury [ 16 ]. Nowadays, primary repair techniques are emerging such as the BEAR technique and the results are appearing to be comparable.…”

The role for high volume local infiltration analgesia with liposomal bupivacaine in total hip arthroplasty: A scoping review

“…An emphasis on pain control in postsurgical patients is partially at fault for the recent increase in opioid prescriptions over the past decade. 29 Further, it is important to acknowledge that the recent increase in opioid prescriptions is not paralleled by an increase in the prescription for non-narcotic analgesics such as nonsteroidal anti-inflammatory drugs. 28 Between 2000 and 2010, opioid prescriptions nearly doubled from 11.3% to 19.6%; however, nonopioid pain medication prescriptions only increased from 26% to 29%.…”

Analgesic Impact of a Popliteal Plexus Block to Standard Adductor Canal Block in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Blind Clinical Trial

“…One of the most common injuries to the knee is an anterior cruciate ligament (ACL) sprain or tear due to trauma [1,2]. ACL damage is crippling and often requires repair with an arthroscopic method, which is an outpatient surgery.…”