Efficacy of Methylprednisolone for Pain Control After ACL Repair

The study is to include consecutive patients who undergo ACL repair by fellowship trained surgeons at a single institution with minimum 12 week follow up. All patients between the ages of 13-50 who are willing and able to provide informed consent will be included. Patients will be assessed preoperatively and then at 2 weeks, 6 weeks,12 weeks, and 1 year clinic visits, which is standard of care. The patient will fill out 2 questions on the MyCap app the day of surgery and for 14 days following surgery for pain scores and 15 days for amount of opioid pills consumed the day prior. Patient demographic, comorbidity, and surgical data will be collected from the medical record, including age, sex, BMI, smoking status, and diabetic status.

Patients will be randomized to the treatment or control group. The treatment group will receive the following pain regimen after surgery: Medrol dose pack, Meloxicam, Hydrocodone/Acetaminophen, and Gabapentin. The control group will be prescribed: Ketoralac, Hydrocodone/Acetaminophen, and Gabapentin. Pain reporting and opioid consumption will be assessed via the MyCap app for two weeks following surgery.

Patients will be followed at standard of care clinic appointments for 1 year. PROMs data will be collected at that time, in addition to any complications.

• Meloxicam 15 mg (Drug): PO once/day for 1 week
• Medrol 4 MG Oral Tablet Includes Medrol Dosepak (Drug): PO 6 day taper
• Gabapentin 300 mg (Drug): PO every 8 hours for 1 week
• Hydrocodone 5Mg/Acetaminophen 325Mg Tab (Drug): PO 1-2 tabs every 4 hours as needed (total of 28 pills)
• Ketorolac 10 Mg Oral Tablet (Drug): PO every 6 hours for 5 days

Primary outcomes

• Numerical Rating Scale (NRS) pain scores [Post-op days 0-14, 2 weeks, 6 weeks, and 12 weeks]: Zero is equivalent to no pain and 10 indicates the worst possible pain

Secondary outcomes

• Opioid consumption after surgery [0-14 days postoperative]: Calculated using Morphine milligram equivalents (MME)

Sex: All, ages: 13 Years to 50 Years

Inclusion Criteria:

* Patient undergoing ACL repair or ACL reconstruction with tendon autograft
* Age 13-50 years old
* Able to provide informed consent or parent/legal guardian is able for minors

Exclusion Criteria:

* Concurrent and significant injury to other bones or organs (Injury Severity Score of 4 or greater)
* Revision ACL reconstruction
* Concomitant additional ligament reconstruction or high tibial osteotomy
* A history of alcohol abuse, substance abuse or chronic opioid use (filled opioid medication ×2 within 6 months of the surgery)
* A history of renal failure (<60 mL/min/1.73 m2), liver dysfunction (child class, >B), severe heart disease (NYHA Class 4), diabetes, neurological or psychiatric diseases that may affect pain perception, and pre-existing immune suppression.
* A history or active peptic ulcer disease, gastrointestinal bleeding, or current use of anticoagulation.
* Patients currently taking oral or injectable glucocorticoids and those who have taken either within 1 month of the procedure.
* Patients who are currently pregnant.
* Patients who are unable to undergo the multimodal pain standardized protocol including those with comorbidities or medical allergies precluding the use of corticosteroids, gabapentin, hydrocodone, acetaminophen, ketorolac, and/or meloxicam.

• Scott Kaar, MD, Principal investigator, St. Louis University