Non-Opioids Provide Effective Pain Relief After ACL Reconstruction, Study Finds
A novel opioid-free pain management protocol developed by sports medicine physicians at the Henry Ford Health System provides a promising answer to the question, “Can patients effectively manage their pain after ACL reconstruction without opioids?”
Their study, published online ahead of print by The American Journal of Sports Medicine, showed that when this protocol is used, patients have the same level of pain relief as they would with the commonly prescribe opioids morphine, hydrocodone, and oxycodone.
“The study constitutes practice-changing research,” said Vasilios (Bill) Moutzouros, MD, Chief of Sports Medicine at Henry Ford and the study’s lead author. “The data [are] powerful in showing [that] we can do such a complex surgery and control postoperative pain without the need for opioid medications.”
Pain Control With and Without Opioids
The retrospective study involved 62 patients who underwent anterior cruciate ligament (ACL) reconstruction between February 2019 and January 2020:
- 28 received opioids for pain control
- 34 received opioid-free pain medicines, including non-steroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants
The researchers found that pain scores from the opioid-free group were equivalent to those of the opioid group. There were no significant differences in adverse effects between the 2 groups, with drowsiness and constipation being the most common adverse effects in both groups.
Studies have shown that patients can become addicted to opioid medications after surgery, including ACL reconstruction. “Our non-opioid approach is a proactive response to advancing pain management practices for our patients,” Dr. Moutzouros said. 
“ACL injury patients and parents of young patients really appreciate the ability to have surgery and have no concern of opioid exposure and chance of misuse.”
Part of a Larger Initiative
In response to the opioid epidemic and ongoing efforts to reduce opioid misuse, Dr. Moutzouros sees the study’s findings as another important step toward the reduction and potential elimination of addictive opioids for pain management of all types of surgeries.
The study resulted from Henry Ford’s broader initiative launched in 2016 to reduce the number of opioid pills and patches.  In 2019, the state of Michigan enacted new laws regulating the prescribing and dispensing of controlled substances including opioid painkillers.  From 1999 to 2016, Michigan saw a 17% increase in fatal prescription drug and opioid overdoses. 
Moutzouros V, Jildeh TR, Tramer JS, et al. Can we eliminate opioids after anterior cruciate ligament reconstruction? A prospective, randomized controlled trial. Am J Sports Med. 2021 Oct 20:3635465211045394. doi: 10.1177/03635465211045394. Online ahead of print.
- Jildeh TR, Khalil LS, Abbas MJ, Jildeh TR, Khalil LS, Abbas MJ, Moutzouros V, Okoroha KR., Okoroha KR. Multimodal nonopioid pain protocol provides equivalent pain control versus opioids following arthroscopic shoulder labral surgery: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2021 Nov;30(11):2445-2454. doi: 10.1016/j.jse.2021.07.008. Epub 2021 Aug 12.
- Henry Ford Health System. What you need to know about new prescribing regulations. https://www.henryford.com/services/pain-management/new-prescribing-regulations. Accessed November 26, 2021.
- Department of Licensing and Regulatory Affairs. Laws and regulations. https://www.michigan.gov/lara/0,4601,7-154-89334_72600_72603_55478_85991—,00.html. Accessed November 26, 2021.
- Michigan Department of Health & Human Services. Prescription drugs and opioids in Michigan. https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_4871_79584—,00.html. Accessed November 26, 2021.