A study highlighting a novel opioid-free pain management protocol developed by sports medicine physicians in the Henry Ford Health System provides a promising answer to the question “Can patients effectively manage their pain after ACL knee reconstruction surgery without opioids?”
Published in The American Journal of Sports Medicine, the study shows that this protocol provided the same pain relief for patients following anterior cruciate ligament (ACL) reconstruction as common types of prescription opioids such as morphine, hydrocodone, and oxycodone.
“The study constitutes practice-changing research,” said Vasilios (Bill) Moutzouros, MD, Chief of Sports Medicine at Henry Ford and the study’s lead author. “The data [are] powerful in showing we can do such a complex surgery and control post-operative pain without the need for opioid medications.”
The retrospective study involved 62 patients who underwent ACL reconstruction between February 2019 and January 2020. Of those patients, 28 received opioids for pain control and 34 received opioid-free pain medicines that included:
- Non-steroidal anti-inflammatory drugs
- Muscle relaxers
The researchers reported that pain scores from the opioid-free group were equivalent to the pain scores of patients who received opioids to manage their pain There were no significant differences in side effects between the 2 groups. Drowsiness and constipation were the most side effects in both groups.
Studies have shown that patients can become addicted to their opioid pain control medications after various types of surgery, including ACL reconstruction. “Our non-opioid approach is a pro-active response to advancing pain management practices for our patients,” Dr. Moutzouros said. 
“[Patients with] ACL injury … and parents of young patients really appreciate the ability to have surgery and have no concern of opioid exposure and chance of misuse.”
The study resulted from Henry Ford’s broader initiative launched in 2016 to reduce the number of opioid pills and patches.  In 2019, the State of Michigan enacted new laws regulating the prescribing and dispensing of controlled substances including opioid painkillers.  From 1999 to 2016, Michigan saw a 17% increase in fatal prescription drug and opioid overdoses. 
Moutzouros V, Jildeh TR, Tramer JS, et al. Can we eliminate opioids after anterior cruciate ligament reconstruction? A prospective, randomized controlled trial. Am J Sports Med. 2021 Oct 20:3635465211045394. doi: 10.1177/03635465211045394. Online ahead of print.
- Jildeh TR, Khalil LS, Abbas MJ, Jildeh TR, Khalil LS, Abbas MJ, Moutzouros V, Okoroha KR., Okoroha KR. Multimodal nonopioid pain protocol provides equivalent pain control versus opioids following arthroscopic shoulder labral surgery: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2021 Nov;30(11):2445-2454. doi: 10.1016/j.jse.2021.07.008. Epub 2021 Aug 12.
- Henry Ford Health System. What you need to know about new prescribing regulations. https://www.henryford.com/services/pain-management/new-prescribing-regulations. Accessed March 14, 2022.
- Department of Licensing and Regulatory Affairs. Laws and regulations. https://www.michigan.gov/lara/0,4601,7-154-89334_72600_72603_55478_85991—,00.html. Accessed March 14, 2022.
- Michigan Department of Health & Human Services. Prescription drugs and opioids in Michigan. https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_4871_79584—,00.html. Accessed March 14, 2022.