2017 ISAKOS Biennial Congress ePoster #1072


Local Anaesthetic Infiltration to the Hamstring Harvest Site in Anterior Cruciate Ligament Reconstruction Reduces Analgesic Requirements – a Randomised Controlled Trial

James O. Smith, BM, BSc(Hons), DM, FRCS, Ringwood UNITED KINGDOM
Pedro Morales, MD, Bournemouth UNITED KINGDOM
Rohit Gangadharan, Chennai, Tamil Nadu INDIA
James Logan, MBBS, BSc, Winchester, Hampshire UNITED KINGDOM
Martin Schuster-Bruce, BSc, MRCP, FRCA, Bournemouth UNITED KINGDOM
Adrian Harvey, Southampton UNITED KINGDOM

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UNITED KINGDOM

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Pennine Healthcare, 14CH pediatric suction catheter


This randomised controlled study investigates the additional post-operative pain relief afforded by topical infiltration of local anaesthetic directly into the hamstring graft harvest site, in comparison to traditional local anaesthetic infiltration with systemic analgesia.



Anterior cruciate ligament (ACL) reconstruction is commonly performed using autologous hamstring tendons. A technique of intra-operative local anaesthetic (LA) infiltration directly into the graft harvest site has been described, although no objective evidence of its efficacy exists. This study investigates the post-operative pain relief afforded by this new technique, in comparison to traditional LA infiltration by measuring subjective pain levels and analgesic requirements over the first 48 hour period following surgery, when the harvest site pain is particularly problematic.


Local and Regional Ethical Committee Approval was granted prior to commencement of this two-treatment parallel-design randomised controlled study. 61 adults undergoing day case arthroscopic ACL reconstruction using autologous hamstring tendons were initially included in the study. Subjects were randomised to receive either: i) standard LA infiltration (20ml of 0.25% levobupivacaine injected into the wounds and around graft site using a standard 21 gauge needle), or ii) the intervention hamstring harvest site infiltration technique (20ml of 0.25% levobupivacaine diluted to 50ml with normal saline, injected directly into the hamstring harvest site using a suction catheter*) at the end of the operative procedure. All patients additionally underwent routine general anaesthetic, femoral nerve blockade using ultrasound guidance, standard intra-articular LA infiltration at the end of the procedure and a standard peri-operative analgesic protocol. Post-operatively, patient pain levels (subjective 0-10 scoring) and total analgesic requirements were recorded at intervals up to 48 hours.


A total of 8 patients were excluded after recruitment, leaving 26 in group 1 (standard arm, mean age 27) and 27 in group 2 (intervention, mean age 31). There was one superficial wound complication in group 1. No specific adverse effects from the intervention were noted. Pain scores at all five time-points up to 48 hours and overall pain (measured as area under the curve) did not differ significantly between groups. Total analgesia and reported oral opiate intake specifically were both significantly reduced in the intervention group during this period (p<0.005 for each criterion).


ACL reconstruction is now frequently performed as day case surgery. In our experience, pain from the hamstring harvest site can be a factor in failed same-day discharge in these patients, with patients complaining of pain extending proximally within the medial thigh. Although femoral nerve or adductor canal blockade is effective at abolishing post-operative knee pain associated with the ACL reconstruction itself, it does not appear to be so efficacious at the hamstring donor site. Our finding that analgesic requirements are significantly reduced following hamstring harvest site infiltration supports the use of the technique described. We hypothesise that no difference in pain scores were seen, because patients were able to self-medicate in the standard group to keep their pain at an acceptable level.

*The suction catheter is used 'off-label' for this approach, as defined by the FDA