J Shoulder Elbow Surg. 2026 Mar 19:S1058-2746(26)00147-3. doi: 10.1016/j.jse.2026.03.005. Online ahead of print.
ABSTRACT
BACKGROUND: Cannabis use has become increasingly common in the general population, with cannabis use disorder (CUD) defined as clinically significant impairment and/or distress related to cannabis consumption. Prior studies have associated CUD with increased postoperative pain and opioid use, but its impact following arthroscopic rotator cuff repair (RCR) remains unclear. This study aimed to compare short- and long-term surgical outcomes following RCR between patients with and without CUD.
METHODS: Using the TriNetX database, we conducted a retrospective cohort study of patients who underwent arthroscopic RCR for full-thickness rotator cuff tears. Patients diagnosed with CUD within three months prior to surgery were compared to patients without any documented history of CUD. 1:1 propensity-score matching was performed to control for demographics and comorbidities, resulting in two matched cohorts. Outcomes within 90 days included postoperative pain, opioid use, mean number of opioid prescriptions, shoulder stiffness, and physical therapy (PT) utilization. Long-term outcomes assessed within two years included upper limb mononeuropathies, shoulder pain or stiffness, conversion to total shoulder arthroplasty, revision RCR, arthroscopic debridement, and new-onset opioid-related disorders.
RESULTS: After matching, 3,012 patients remained in each cohort with no significant differences in baseline characteristics. In the first 14 days postoperatively, CUD patients had higher rates of opioid use (42.0% vs. 35.9%, p < 0.0001), acute pain (4.2% vs. 2.6%, p = 0.0008), and a greater number of opioid prescriptions (0.677 ± 1.137 vs. 0.539 ± 0.959, p < 0.0001). These differences persisted through postoperative days 15-42, during which CUD patients also attended fewer PT sessions (2.685 ± 1.941 vs. 3.158 ± 2.334, p < 0.0001). From days 43-90, opioid-related outcomes were similar between groups, though CUD patients continued to have fewer PT visits (3.858 ± 3.187 vs. 4.584 ± 3.719, p < 0.0001). No significant differences were observed in long-term complications at two years.
CONCLUSION: For patients undergoing arthroscopic RCR, a coded diagnosis of CUD was associated with increased early postoperative pain, greater opioid requirements, and lower PT participation within 90 days of surgery. More research is required to investigate the nature of this association.
PMID:41864603 | DOI:10.1016/j.jse.2026.03.005