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J Knee Surg 2022; 35(02): 167-175
DOI: 10.1055/s-0040-1713777
Original Article

Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management

Lafi S. Khalil 
1   Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Toufic R. Jildeh
1   Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Najib Ussef
1   Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Tahsin Rahman
1   Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Erika Carter
2   School of Medicine, Wayne State University School of Medicine, Detroit, Michigan
,
Megan Pawloski
2   School of Medicine, Wayne State University School of Medicine, Detroit, Michigan
,
Marissa Tandron
2   School of Medicine, Wayne State University School of Medicine, Detroit, Michigan
,
Vasilios Moutzouros
1   Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
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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.




Publication History

Received: 02 March 2020

Accepted: 24 May 2020

Article published online:
08 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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