Stimulant Usage in Attention-Deficit/Hyperactivity Disorder Is Associated With Decreased Rates of Arthrofibrosis and Postoperative Complications Following Anterior Cruciate Ligament Reconstruction.

Abstract

Anterior cruciate ligament (ACL) tears are one of the most common orthopaedic injuries, and ACL reconstruction is often considered the standard of care for the active individual. Recently, attention-deficit/hyperactivity disorder (ADHD) has been shown to be a risk factor for adverse postoperative outcomes in patients undergoing ACL reconstruction. However, no studies have looked at the effect of stimulant medications on ACL reconstruction outcomes in patients with ADHD. This study aimed to compare postoperative outcomes between ADHD patients using stimulant medications and those not using stimulants following ACL reconstruction at 3- and 6-month follow-up. This retrospective cohort study used the TriNetX database to identify patients with ADHD who underwent ACL reconstruction surgery and divided them into cohorts based on the presence or absence of stimulant medication usage. Patient cohorts were 1:1 propensity score matched on age, sex, obesity, mood disorders, anxiety disorders, and nicotine dependence. Postoperative complications were analyzed within 3 and 6 months postoperatively, evaluating arthrofibrosis, infection, wound disruption, revision surgery, emergency department (ED) visits, hospital readmission, and deep vein thrombosis. Within 3 and 6 months postoperatively, ADHD patients not taking stimulants were markedly more likely to return to the ED and be readmitted to a hospital compared with those who were taking stimulants. In addition, at the 6-month time point, a statistically significant increase in arthrofibrosis was seen in nonstimulant users compared with stimulant users in patients with ADHD. This study found that patients with ADHD not taking stimulant medications are at an increased risk of returning to the ED, being readmitted to the hospital, and developing arthrofibrosis compared with those patients taking stimulants following ACL reconstruction. The results display the importance of identifying modifiable risk factors for ACL reconstruction surgery so that physicians can adequately adjust treatment regimens to each patient.