According to a study presented at the AAOS 2024 Annual Meeting, the perioperative use of cannabidiol (CBD) for pain management was not associated with deficits in patient-reported pain control, satisfaction, or functional outcomes when compared with a placebo control at least 1 year after arthroscopic rotator cuff repair (ARCR). The study was presented by Michael J. Alaia, MD, FAAOS, associate professor at NYU Grossman School of Medicine and codirector of the Sports Medicine Fellowship at NYU Langone Health.

“This study was an extension of a prior study that was published in the American Journal of Sports Medicine that showed higher patient satisfaction and better pain control in patients receiving cannabidiol immediately after arthroscopic rotator cuff repair, as compared to placebo,” Dr. Alaia explained. “However, it is unknown if the use of CBD after surgery can affect healing and, by extension, outcomes long after surgery.”

To illuminate the long-term outcomes of CBD after ARCR, Dr. Alaia and colleagues examined follow-up data from 83.8 percent of the patients who had previously participated in the multicenter, placebo-controlled, randomized, double-blinded trial.

Patients in the experimental group (n = 42) received either 25 mg of CBD three times daily (TID) for individuals weighing <80 kg or 50 mg of cbd tid for those weighing>>80 kg over a 14-day period, whereas patients in the control group received identically appearing placebo doses (n = 40). No significant distinctions in age, sex, BMI, concomitant procedures, or intraoperative anchor usage were observed between the CBD and placebo groups.

Follow-up, which occurred at least 1 year after surgery, included outcome measurements such as the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and patient satisfaction.

“The results of the study showed that there were no major differences in patient outcomes at 1-year follow-up in those receiving CBD immediately after arthroscopic rotator cuff repair compared to placebo,” Dr. Alaia said. Specifically, VAS pain (0.8 versus 1.2, P = 0.384), ASES score (93.0 versus 91.1, P = 0.714), and SANE score (87.6 versus 90.1, P = 0.236) showed no significant differences between the two groups. Almost all patients (98.8 percent) reported that the surgery had met their expectations. Subgroup analysis revealed no noteworthy variations in patient-reported outcomes among those receiving the 25 mg dose, 50 mg dose, or placebo (P >0.05).

Dr. Alaia acknowledged the study’s limitations. First, it did not evaluate radiographic outcomes, “so we cannot make assumptions about biological healing of the tendon.,” he said. Dr. Alaia also noted that the 1-year follow-up period was “relatively short-term.”

“The use of small doses of CBD after surgery appears to be safe and well tolerated,” Dr. Alaia said, and he looked to future research to dive more deeply into the use of CBD during and after surgery. “Perhaps higher doses would maintain their safety profile and provide better relief after surgery without a longer-term detrimental effect,” he said.

In this study, utilizing CBD for pain management during ARCR surgery did not lead to notable impairments in terms of patient-reported pain, satisfaction, or functional outcomes at a minimum of 1 year after surgery when compared to a placebo. These results suggest that incorporating CBD into a postoperative multimodal pain-management plan is a viable option without adverse effects on the overall outcome.

Dr. Alaia’s coauthors of “Cannabidiol for Postoperative Pain Control after Arthroscopic Rotator Cuff Repair Demonstrates No Functional Deficits: 1-Year Follow-Up of a Randomized Controlled Trial” are Andrew S. Rokito, MD, FAAOS; Eoghan T. Hurley, MCH (ORTH )(UK), MD, PhD; Guillem Gonzalez-Lomas, MD, FAAOS; Isabel Chalem, BS; Kevin Kaplan, MD; Kinjal Vasavada, BA; Laith M. Jazrawi, MD, FAAOS; and Zachary Li.

Cailin Conner is the associate editor of AAOS Now. She can be reached at cconner@aaos.org.

Reference

1. Alaia MJ, Hurley ET, Vasavada K, et al: Buccally absorbed cannabidiol shows significantly superior pain control and improved satisfaction immediately after arthroscopic rotator cuff repair: a placebo-controlled, double-blinded, randomized trial. Am J Sports Med 2022;50(11):3056-63.