Cannabis Use Disorder Did Not Worsen Outcomes After ACL Surgery

What the researchers found

There were no significant differences between CUD and non-CUD patients in opioid prescription rates (82.7% vs 83.7%), total opioid days supply, total morphine milligram equivalents, or improvement on any of five patient-reported outcome measures (pain intensity, pain interference, mobility, mental health, physical health).

Why it matters

There is a common concern that patients with substance use disorders may have worse surgical outcomes or require more pain medication. This study found no evidence to support those concerns for CUD patients undergoing ACL reconstruction.

The numbers in context

104 CUD patients matched to 104 controls. 65.4% male. Mean age 29.9 years. Mean follow-up 16.1 months. Opioid prescription rates: 82.7% vs 83.7% (p > 0.99). No significant differences in MMEs (p = 0.71), days supply (p = 0.67), or any PROMIS score (all p > 0.50).

How the study worked

Retrospective matched-cohort study at a single center. 104 patients with CUD who underwent primary ACL reconstruction were propensity-score matched 1:1 to controls on age, sex, and follow-up time. Opioid use was tracked for up to 1 year, and PROMIS instruments assessed outcomes.

What this study cannot tell us

Retrospective single-center design. Sample size was not determined a priori, so the study may be underpowered to detect real differences. CUD diagnosis was based on medical records and may not capture all cannabis users. Propensity matching on only three variables may leave residual confounding.

How to read the evidence

Well-designed matched cohort with validated outcome measures, though limited by single center and potentially underpowered sample.

When this study was published

2024 study

The bigger picture

This adds to a growing body of evidence suggesting that cannabis use disorder alone may not be a reason to alter surgical planning or post-operative care. Stigma around substance use disorders can lead to undertreatment of pain, and data like this can inform more evidence-based decision-making.

Questions still open

• Would a larger study reveal differences that this one missed? Do outcomes differ for patients with active heavy cannabis use vs those with a CUD diagnosis who may be in recovery? Does cannabis use affect healing biology even if patient-reported outcomes are similar?

Common questions

Read the original research

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

Sports health, 16(5), 687-694

Citation

Shankar, Dhruv S; DeClouette, Brittany; Vasavada, Kinjal D; Avila, Amanda; Strauss, Eric J; Alaia, Michael J; Gonzalez-Lomas, Guillem. (2024). Cannabis Use Disorder Not Associated With Opioid Analgesic Use or Patient-Reported Outcomes After ACL Reconstruction: A Retrospective Matched-Cohort Analysis.. Sports health, 16(5), 687-694. https://doi.org/10.1177/19417381231190391

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