Anterior cruciate ligament reconstruction (ACLR) is associated with postoperative pain and necessitates using perioperative nerve blocks and multimodal analgesic plans.
This study assessed postoperative pain and daily opioid use between ACL repair and ACLR and assessed whether ACL repair could also be performed without using long-acting nerve blocks.
Level of evidence: Prospective cohort study, level II
All eligible patients undergoing ACL surgery between 2019-2022 were prospectively enrolled. Patients were treated with the treatment algorithm of undergoing primary repair if proximal tears with sufficient tissue quality were present and otherwise underwent single-bundle ACLR with either hamstring or quadriceps autograft. Patients were divided into three groups: ACLR with nerve block, which is standard of care, and primary repair with and without nerve block. Pain scores on a visual analog scale and number of opioids used were recorded during the first 14 postoperative days (POD). Furthermore, patients completed the Quality of Recovery (QoR-15) survey and range of motion (ROM) was assessed. For final analysis, ACLR was compared with primary repair with nerve block and repair patients with and without blocks were also compared. Group differences were compared using Mann-Whitney U tests and chi-square tests.
Seventy-eight patients were included, of which 30 (39%) underwent ACLR, 19 (24%) ACL repair with nerve block, and 29 (37%) ACL repair without nerve block. Repair patients with nerve block used significantly fewer opioids than those treated with ACLR on POD 1 (0 vs. 3, p=0.010) and POD 2 (1 vs. 3 pills, p=0.014) while also using less opioids in total (1 vs. 8, p=0.029, respectively). QoR-15 scores were significantly higher throughout the first postoperative week for patients undergoing ACL repair, and repair patients had more ROM (p <.05). Comparing repair patients with and without nerve block, there were no statistical differences in pain scores, opioids use, and QoR-15 scores (all p>0.05).
ACL primary repair patients experienced less postoperative pain during the first two weeks after surgery while even using significantly less opioids than those treated with ACLR. Furthermore, improved knee function and higher recovery quality than in patients undergoing ACLR was observed. Finally, postoperative nerve blocks might not be necessary after ACL primary repair.