Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management

Abstract

The purpose of this study was to determine (1) the correlation between preoperative and postoperative opioid use and (2) risk factors associated with rerupture in patients undergoing open extensor mechanism repair. A retrospective review of patients who underwent operative repair of quadriceps or patellar tendon rupture was performed. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before surgery, or as acute users or chronic users if they received at least one opioid prescription within 1 month or 3 months preceding surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery as well as rerupture rates. A total of 144 quadriceps tendon and 15 patellar tendon repairs were performed at a mean age of 56.8 ± 15.1 years and body mass index of 33.2 ± 7.1. The overall rerupture rate was 6%. Diabetes was a significant risk factor for rerupture (56 vs. 19%, p = 0.023). Chronic preoperative opioid users were more likely to continue to use opioids beyond 1 month postoperatively (p < 0.001) as compared with acute or nonopioid users. Chronic preoperative opioid users (relative risk [RR]: 3.53, 95% confidence interval [CI]: 2.11–5.90) and patients with longer anesthesia time (RR: 1.39, 95% CI: 1.00–1.93) required more monthly opioid refills, whereas tourniquet use required fewer opioid refills each month (RR: 0.57, 95% CI: 0.37–0.88). Compared with patients without a rerupture, each additional prescription refill after the initial repair in the rerupture group was associated with a 22% higher risk of tendon rerupture (RR: 1.22, 95% CI: 1.07–1.39). The chronicity of preoperative opioid intake was found to have a significant effect on postoperative opioid use. This study suggests that there is a higher prevalence of rerupture in patients with prolonged opioid use postoperatively and among diabetics.

Keywords

quadriceps tendon ruptures - extensor mechanism ruptures - rerupture - opioid - preoperative opioid

Note

This project was reviewed and approved by the institutional review board at Henry Ford Hospital, the main institution of the attending physician conducting the research.

Publikationsverlauf

Eingereicht: 02. März 2020

Angenommen: 24. Mai 2020

Artikel online veröffentlicht:
08. Juli 2020

• References

• 1 Lee D, Stinner D, Mir H. Quadriceps and patellar tendon ruptures. J Knee Surg 2013; 26 (05) 301-308
• 2 Saragaglia D, Pison A, Rubens-Duval B. Acute and old ruptures of the extensor apparatus of the knee in adults (excluding knee replacement). Orthop Traumatol Surg Res 2013; 99 (01) S67-S76
• 3 Reito A, Paloneva J, Mattila VM, Launonen AP. The increasing incidence of surgically treated quadriceps tendon ruptures. Knee Surg Sports Traumatol Arthrosc 2019; 27 (11) 3644-3649
• 4 Ibounig T, Simons TA. Etiology, diagnosis and treatment of tendinous knee extensor mechanism injuries. Scand J Surg 2016; 105 (02) 67-72
• 5 Pengas IP, Assiotis A, Khan W, Spalding T. Adult native knee extensor mechanism ruptures. Injury 2016; 47 (10) 2065-2070
• 6 Marn-Vukadinović D, Bizovičar N, Majdič N, Vidmar G. Pain and outcome prediction in muscle strength rehabilitation after knee injury in recreational athletes. Int J Rehabil Res 2019; 42 (02) 168-173
• 7 Jones Jr J, Southerland W, Catalani B. The importance of optimizing acute pain in the orthopedic trauma patient. Orthop Clin North Am 2017; 48 (04) 445-465
• 8 Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths–United States, 2000–2014. MMWR Morb Mortal Wkly Rep 2016; 64 (50–51): 1378-1382
• 9 Daoust R, Paquet J, Moore L. et al. Recent opioid use and fall-related injury among older patients with trauma. CMAJ 2018; 190 (16) E500-E506
• 10 Jildeh TR, Taylor KA, Khalil LS. et al. Risk factors for postoperative opioid use in arthroscopic meniscal surgery. Arthroscopy 2019; 35 (02) 575-580
• 11 Anthony CA, Westermann RW, Bedard N. et al. Opioid demand before and after anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (13) 3098-3103
• 12 Menendez ME, Ring D, Bateman BT. Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res 2015; 473 (07) 2402-2412
• 13 Lawrence JT, London N, Bohlman HH, Chin KR. Preoperative narcotic use as a predictor of clinical outcome: results following anterior cervical arthrodesis. Spine 2008; 33 (19) 2074-2078
• 14 Lee D, Armaghani S, Archer KR. et al. Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am 2014; 96 (11) e89
• 15 Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB. Preoperative opioid use and outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2015; 24 (01) 11-16
• 16 Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA 2011; 305 (13) 1299-1301
• 17 Serino J, Mohamadi A, Orman S. et al. Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: a systematic review and network meta-analysis. Injury 2017; 48 (12) 2793-2799
• 18 Rao AG, Chan PH, Prentice HA, Paxton EW, Funahashi TT, Maletis GB. Risk factors for opioid use after anterior cruciate ligament reconstruction. Am J Sports Med 2019; 47 (09) 2130-2137
• 19 McLaughlin DC, Cheah JW, Aleshi P, Zhang AL, Ma CB, Feeley BT. Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study. J Shoulder Elbow Surg 2018; 27 (04) 686-691
• 20 Gessner DM, Horn JL, Lowenberg DW. Pain management in the orthopaedic trauma patient: Non-opioid solutions [published online ahead of print, 2019 Apr 25]. Injury 2019; ;S0020–1383(19)30224–4
• 21 Derogatis MJ, Sodhi N, Anis HK, Ehiorobo JO, Bhave A, Mont MA. Pain management strategies to reduce opioid use following total knee arthroplasty. Surg Technol Int 2019; 35: 301-310
• 22 Jain N, Brock JL, Malik AT, Phillips FM, Khan SN. Prediction of complications, readmission, and revision surgery based on duration of preoperative opioid use: analysis of major joint replacement and lumbar fusion. J Bone Joint Surg Am 2019; 101 (05) 384-391
• 23 Goplen CM, Verbeek W, Kang SH. et al. Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20 (01) 234
• 24 O'Donnell JA, Anderson JT, Haas AR. et al. Preoperative opioid use is a predictor of poor return to work in workers' compensation patients after lumbar diskectomy. Spine 2018; 43 (08) 594-602
• 25 Rogers MJ, Adeyemi TF, Kim J, Maak TG. Understanding preoperative demographics and risk factors for early revision surgery in patients undergoing hip arthroscopic surgery: a large database study. Orthop J Sports Med 2019; 7 (06) 2325967119849579
• 26 Söderberg KC, Laflamme L, Möller J. Newly initiated opioid treatment and the risk of fall-related injuries. A nationwide, register-based, case-crossover study in Sweden. CNS Drugs 2013; 27 (02) 155-161
• 27 Kubo Y, Wruck CJ, Fragoulis A. et al. Role of Nrf2 in fracture healing: clinical aspects of oxidative stress. Calcif Tissue Int 2019; 105 (04) 341-352
• 28 Yepes H, Tang M, Geddes C, Glazebrook M, Morris SF, Stanish WD. Digital vascular mapping of the integument about the Achilles tendon. J Bone Joint Surg Am 2010; 92 (05) 1215-1220
• 29 Reich MS, Fernandez I, Mishra A, Kafchinski L, Adler A, Nguyen MP. Diabetic control predicts surgical site infection risk in orthopaedic trauma patients. J Orthop Trauma 2019; 33 (10) 514-517
• 30 Hikata T, Iwanami A, Hosogane N. et al. High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthop Sci 2014; 19 (02) 223-228
• 31 Akiboye F, Rayman G. Management of hyperglycemia and diabetes in orthopedic surgery. Curr Diab Rep 2017; 17 (02) 13
• 32 Rizvi AA, Chillag SA, Chillag KJ. Perioperative management of diabetes and hyperglycemia in patients undergoing orthopaedic surgery. J Am Acad Orthop Surg 2010; 18 (07) 426-435