Adductor Canal Nerve Versus Femoral Nerve Blockade for Pain Control and Quadriceps Function Following Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: A Prospective Randomized Trial

Abstract

To compare femoral nerve blockade (FNB) versus adductor canal nerve blockade (ACB) for postoperative pain control and quadriceps muscle function in patients undergoing anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft. A randomized therapeutic trial of 90 patients undergoing ACL reconstruction with patellar tendon autograft was conducted comparing ACB versus FNB at 24hours, 2 and 4 weeks, and 6months postsurgery. Early outcome measures included average pain score and morphine equivalent units (milligrams) consumed, quadriceps surface electromyography, straight leg raise, and ability to ambulate without assistive devices. The 6-month outcome measures included knee range of motion (ROM), isokinetic knee extension peak torque, single-leg squat, and single-leg hop performance. Complications were recorded throughout the study for the development of anterior knee pain, knee extension ROM loss, deep vein thrombosis, and graft failure. Mixed-model analysis of variance and Mann-Whitney U tests were performed using an alpha of .05. Quadriceps surface electromyography deficits were higher for FNB at 24hours (P < .001) and 2weeks (P < .001) when compared with the ACB group. There were no between-groups difference for subjective pain (P= .793) or morphine consumption (P= .358) within the first 24hours of surgery. A higher percentage of patients in the ACB group met the full ambulation criteria at 4weeks compared with the FNB group (100% vs 84.2%, P < .001). No between-group differences were observed at 6months; however, the rate of knee extension ROM loss was higher for the FNB group versus the ACB group (21.1% vs 5.0%, P= .026), respectively. ACB was as effective as FNB at providing pain control while eliciting fewer quadriceps muscle activation deficits and fewer postoperative complications. Based on previous evidence and the results of this study, we recommend the use of ACB over FNB for theanalgesic management of patients undergoing ACL reconstruction with patellar tendon autograft. Level I, prospective randomized controlled trial.