Opiate prescribing patterns in the adolescent population following anterior cruciate ligament reconstruction


  • Alexander Karius, BS
  • Eli M. Cahan, BBA
  • Nicole A. Segovia, BS
  • Austin Fan, BA
  • Charles M. Chan, MD




opiates, ACL, Reconstruction


Objective: We sought to determine prescribing patterns for opioid analgesia following anterior cruciate ligament (ACL) reconstruction among age- and gender-stratified adolescents in a nationally representative database.

Design: A retrospective study.

Setting: PearlDiver Patient Records.

Patients, participants: Outpatient opioid claims within 30 days of surgery were extracted. The patients were defined into age groups 10-14 (“younger’) and 15-19 (“older”). A total of 1,139 patients were included in this study (536 female and 603 males) with 108 patients in the 10-14 age category and 1,034 patients in the 15-19 category.

Main outcome measure(s): The primary study outcome measures the average number of opioid pills administered, average total morphine milligram equivalents (MMEs) prescribed, and the average prescription strength (MMEs/pill).

Results: No difference was found in the average number of pills (p = 0.26) or normalized total MMEs (p = 0.312) prescribed by age group. Normalized total morphine equivalents per prescription was significantly lower in females than males (p = 0.005). Multivariate linear regression analysis demonstrated that increasing patient age was predictive of fewer total pills (p = 0.017), after accounting for gender.

Conclusions: There are age- and gender-based disparities in prescription patterns for adolescent ACL reconstruction. Our findings indicate that patients in the older age group on average received fewer pills than the younger age group, which consequently trended toward receiving higher total MMEs prescribed. This suggests that surgeons may be inadvertently overprescribing in the younger cohort. Additional studies that account for concurrent factors should be conducted to observe potentially similar trends.

Author Biographies

Alexander Karius, BS

Department of Pediatric Orthopaedics, Stanford University, Stanford, California

Eli M. Cahan, BBA

Department of Pediatric Orthopaedics, Stanford University, Stanford, California; New York University School of Medicine, New York, New York

Nicole A. Segovia, BS

Department of Pediatric Orthopaedics, Stanford University, Stanford, California

Austin Fan, BA

Department of Pediatric Orthopaedics, Stanford University, Stanford, California

Charles M. Chan, MD

Department of Pediatric Orthopaedics, Stanford University, Stanford, California


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How to Cite

Karius, BS, A., E. M. Cahan, BBA, N. A. Segovia, BS, A. Fan, BA, and C. M. Chan, MD. “Opiate Prescribing Patterns in the Adolescent Population Following Anterior Cruciate Ligament Reconstruction”. Journal of Opioid Management, vol. 17, no. 4, July 2021, pp. 321-5, doi:10.5055/jom.2021.0664.