Cannabis Use Disorder Not Associated With Opioid Analgesic Use or Patient-Reported Outcomes After ACL Reconstruction: A Retrospective Matched-Cohort Analysis.

BACKGROUND: The purpose of this study was to compare opioid analgesic use and patient-reported outcomes (PROs) after anterior cruciate ligament reconstruction (ACLR) between patients with and without cannabis use disorder (CUD).

HYPOTHESIS: We hypothesized that patients with CUD would have greater postoperative opioid usage with comparable improvement in PROs.

STUDY DESIGN: Retrospective matched-cohort study.

LEVEL OF EVIDENCE: Level 3.

METHODS: We identified patients with CUD who underwent primary ACLR at a single center and had minimum 3-month follow-up. Patients with CUD were propensity score matched 1:1 to non-CUD controls with respect to age, sex, and follow-up time. Total refills, days supply, and morphine milligram equivalents (MMEs) of opioid analgesics prescribed were calculated for up to 1 year postoperatively. Patient-Reported Outcome Information System (PROMIS) instruments were used to assess PROs. Opioid use and outcomes were compared between CUD and control groups using Mann-Whitney test and Fisher's exact test. values <0.05 were considered significant.

RESULTS: A total of 104 patients with CUD were matched to 104 controls. Both groups were majority male (65.4% male, 34.6% female). The CUD group had a mean age of 29.9 years and mean follow-up time of 16.1 months. There was no significant intergroup difference in opioid prescription rates (CUD 82.7% vs control 83.7%, ≥ 0.99). Among patients prescribed opioids, there were no significant intergroup differences in total days supply ( = 0.67), total MMEs ( = 0.71), or MMEs per day ( = 0.65). There were no significant differences in pre- to postoperative improvement in PROMIS Pain Intensity ( = 0.51), Pain Interference ( = 0.81), Mobility ( = 0.90), Mental Health ( = 0.74), or Physical Health ( = 0.94).

CONCLUSION: There were no significant differences detected in opioid usage or PRO improvement after ACLR between patients with CUD and those without. However, because a sample size was not determined a priori, a larger sample may show a difference.

CLINICAL RELEVANCE: CUD does not appear to correlate with inferior outcomes after ACLR.