Opioid Prescribing Practices After Anterior Cruciate Ligament Reconstruction: A Systematic Review

The effect of the opioid epidemic has caused legislators and physicians alike to consider limitations on opioid prescription sizes. For anterior cruciate ligament reconstruction (ACLR) in particular, current knowledge is lacking on the size of postoperative opioid prescriptions written by orthopaedic surgeons.

This review sought to quantify opioid prescriptions after ACLR. It was hypothesized that no consensus would exist among orthopaedic surgeons regarding current prescribing practices, leading to variability in prescription amounts.

Systematic review; Level of evidence, 3.

Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a literature search was performed using PubMed, MEDLINE, Ovid Embase, Scopus, and Cochrane CENTRAL databases from each database's inception through August 12, 2022. Search terms included "anterior cruciate ligament reconstruction," "opiate alkaloids," "hydrocodone," "oxycodone," and "narcotics." Studies were included if they quantified postoperative opioid prescriptions. The exclusion criteria included pediatric studies, abstracts or conference papers, reviews, unpublished randomized controlled trials, case reports, and papers not in the English language. Methodological Index for Non-Randomized Studies criteria were used to evaluate the quality of all included studies. This search strategy yielded a total of 1668 studies.

Eight studies quantified postoperative ACLR opioid prescriptions. Initial prescription amount in the absence of legislation or guidelines ranged, on average, from 49.78 opioid tablets to 104.5 opioid tablets, with prescription amounts varying by regions of the United States. Half of the studies (n = 4) examined the effect of opioid-limiting legislation or guidelines on prescribing practices. They found that enactment correlated with significant decreases in the number of opioids prescribed. When pain interventions were given to supplement opioid prescriptions, prescribers also decreased their prescription size.

Our review demonstrates that differences exist in the quantity of oral opioids prescribed to patients undergoing ACLR. Opioid limiting legislation is effective in decreasing prescription size. However, there is no consistency of data used as evidence for guiding opioid-limiting legislation. This review is the first to explore opioid prescription size after ACLR and underscores the need for further research exploring patient opioid consumption, particularly as a means for formulating data-driven legislation.