Opioid Analgesics Are Not Required After Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study

PURPOSE: Opioids are associated with significant side effects and abuse potential. Surgeons aim to minimize exposure while maintaining adequate pain control. This study examines whether opioid medications are necessary for adequate analgesia following anterior cruciate ligament reconstruction (ACLR). METHODS: All patients undergoing ACLR were enrolled in a patient-reported outcomes database. Patients<40 years old at time of surgery were included. Prior to the initiation of opioid-free ACLR, patients underwent ACLR with a standard-opioid protocol. After the initiation of an opioid-free ACLR, the opioid was removed. All patients were counseled that a rescue opioid prescription would be issued if adequate analgesia was not obtained. All patients underwent ACLR by a single surgeon, fellowship-trained in sports medicine. Patients were assessed pre-operatively and at two weeks, six weeks, three months, six months and one year post-operatively. Pain was assessed using the Visual Analog Scale (VAS). Need for opioid medication and quantity of opioid consumption was assessed at two weeks post operatively. RESULTS: 96 patients were included; 73 patients mean age 29.1±11.9 years prior to implementation of opioid-free protocol and 23 patients mean age 20.7±7.2 years after implementation. 2-week postoperative VAS scores were significantly lower in the opioid-free group (1.2±1.2 vs. 2.5±1.9, p<0.001). VAS scores at other time points did not differ significantly between the groups. No patients required a rescue opioid prescription. CONCLUSION: This study serves as proof-of-concept that opioids are not required after primary ACLR in young patients. Patients with access to opioid prescription did not seek rescue opioids at any point in the study period. LEVEL OF EVIDENCE: Level III - Retrospective cohort study Keywords: Anterior Cruciate Ligament; ACL; Reconstruction; Opioid Free; Analgesia.