Cannabis use is associated with increased postoperative complications and healthcare utilization following knee arthroscopy: A propensity-matched cohort study

Background Cannabis use disorder (CUD) is increasingly encountered, but its association with outcomes after knee arthroscopy is unclear. Purpose/Hypothesis To compare postoperative complications, healthcare utilization, and subsequent procedures after primary knee arthroscopy in patients with versus without CUD. We hypothesized that CUD would be associated with higher complication, healthcare utilization, and reoperation rates. Methods A retrospective multicenter cohort study was performed. Patients undergoing primary knee arthroscopy from 2015 to 2025 were identified. CUD was defined by preoperative diagnoses of cannabis use, abuse, and/or dependence. Exclusion criteria included prior knee surgery, corticosteroid injection within 3 months, or <1 year follow-up. Propensity score matching (1:1) was performed based on demographics, comorbidities, and index procedure(s). Outcomes were 90-day and 1-year rates of surgical and medical complications, including infection and reoperation. Statistical significance was determined using odds ratios (ORs) with 95% confidence intervals (CIs). Results Among 3810 patients with CUD and 213,560 without CUD meeting eligibility criteria, 3805 per group were matched. At 90 days, CUD was associated with increased odds of surgical site infection (OR 2.189; 95% CI 1.071–4.476), wound complications (OR 2.143; 95% CI 1.159–3.964), oral antibiotic prescription (OR 1.468; 95% CI 1.260–1.710), emergency department visits (OR 2.036; 95% CI 1.748–2.372), and hospital admissions (OR 1.651; 95% CI 1.251–2.179). At 1 year, CUD was associated with increased odds of irrigation and debridement (OR 2.175; 95% CI 1.096–4.316), repeat knee arthroscopy (OR 1.285; 95% CI 1.061–1.557), anterior cruciate ligament reconstruction (1.448; 95% CI 1.007–2.084), and meniscectomy (OR 1.555; 95% CI 1.173–2.061). Conclusion Preoperative CUD was associated with increased infection-related complications, unplanned healthcare utilization, and subsequent knee procedures after primary knee arthroscopy.