Purpose

Effective pain relief following ACL reconstruction surgery is important for patient satisfaction, recovery, and rehabilitation. However, the impact of autograft selection on the magnitude and trajectory of pain has not been systematically compared between three commonly used grafts: bone-patellar tendon-bone (BPTB), hamstring semitendinosus/gracilis (STG), and quadriceps tendon (QT) autografts. Having insight into the magnitude of pain and analgesic use based on graft choice selection may provide a basis for patient education and guide prescription practices. The objective of this study was to characterize postoperative pain and analgesic use in the first 14 days following primary ACL reconstruction between BPTB, STG, and QT autograft.

Method

This is a secondary analysis of a larger prospective longitudinal study in which long-term clinical and functional outcomes of BPTB, STG, and QT autografts are compared. Patients were recruited at the time of initial consult for primary ACL rupture with each of five participating surgeons assigned to perform a specific ACL graft reconstruction throughout the study (two BPTB, two QT, one STG). Surgical techniques and perioperative orders were not standardized. The same post-operative rehabilitation was provided to all patients. Pain was based on a 10-cm visual analogue scale (VAS) and recorded twice daily on the first two days, and once daily for days three to 14. Analgesic type and quantity were recorded in four-hour increments starting the evening after their surgery and for 14 days postoperatively. Analgesics were divided into three categories: oral opioids, oral nonsteroidal anti-inflammatories, and acetaminophen. Opioids prescribed included Tramacet (tramadol with acetaminophen), tramadol, Percocet (oxycodone with acetaminophen), oxycodone, Tylenol #3 (acetaminophen with codeine), and hydromorphone. Medications with opioid and acetaminophen components were counted in both categories. Pain and analgesic use were compared based on one-way analysis of variance.

Results

Ninety-four patients (25.0 ± 7.7 years; 49 males, 45 females) participated in the study. There were 27 BPTB, 36 STG, and 31 QT autografts. There were no differences in pain scores between graft type at any time point. Peak pain scores (mean ± SD) were seen at Day 1 morning (6.1 ± 0.4), Day 1 evening (6.3 ± 0.4), and Day 2 morning (5.9 ± 0.4) for the STG, QT and BPTB groups, respectively. There were no differences between grafts in the mean number of analgesic pills of each category taken per day or the total number of analgesic pills taken at 48-hours, seven- and 14-days postoperative. No patients required hospital admission or presented to the emergency department due to uncontrolled pain. On Day 14 postoperative, four, six, and seven patients used opioids for BPTB (range 1-12 pills), STG (range 1-9 pills), and QT (range 1-4 pills), respectively.

Conclusion

Graft type did not impact early (14-day) post-operative pain with respect to magnitude or timing of peak pain nor did it impact analgesic use in primary ACL reconstruction. Health care practitioners may use this information to guide patient education and expectations regarding the various graft options of ACL surgery with respect to trajectory of recovery and analgesic use post-operatively.