Effect of Marijuana Use on Pain Management and Return to Sport After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients: A Matched Control Study

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Abstract
Background: The increasing prevalence of marijuana usage has prompted research into the potential medical effects. Yet, there is a paucity of literature surrounding the impact on perioperative outcomes after orthopaedic surgeries among pediatric and adolescent populations. Purpose: To compare perioperative outcomes between pediatric and adolescent patients who underwent anterior cruciate ligament reconstruction (ACLR) and attested to marijuana use compared with those who did not attest to marijuana use, and whether sociodemographic factors were associated with positive self-reported marijuana attestation. Study Design: Cohort study; Level of evidence, 3. Methods: This study evaluated perioperative outcomes in patients aged ≤20 years who underwent primary ACLR between January 2011 and December 2017. Patients were divided based on self-reported positive marijuana attestation on forms collected during the surgical intake process. Propensity score matching (3:1 ratio) was used to select matched controls based on age, sex, surgeon, and graft type. Perioperative outcomes and complications were compared between those who self-reported positive marijuana attestation and those who did not report marijuana use. Results: Of 4358 eligible patients, 42 self-reported positive marijuana use on attestation forms (0.96% [95% CI, 0.70-1.30]), with 126 patients in the matched cohort. The mean follow-up was 25.26 months (SD, 27.17 [range, 1-125 months). Patients who self-reported positive marijuana use (n = 42) experienced significantly higher rates of overnight admission for pain (90% vs 29%; P = .004), greater estimated blood loss (10 vs 3 mL; P < .001), lower maximum heart rate in the postanesthesia care unit (74.3 ± 12.8 vs 80.2 ± 14.8 beats per min; P = .04). Time to return to sports (RTS) was 76 days longer in the self-reported positive marijuana attestation cohort (95% CI, 1.1-1.5; P < .001). Higher odds of positive self-reported marijuana attestation were observed in patients living in lower Child Opportunity Index neighborhoods, those identifying as races other than White, and those of Hispanic ethnicity. Conclusion: Positive self-reported marijuana attestation in pediatric and adolescent patients undergoing ACLR was associated with higher rates of overnight admission for pain and prolonged time to RTS, suggesting potential implications for perioperative management and recovery.

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