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
