Abstract
Purpose
To determine whether femoral nerve blockade (FNB) at the time of primary ACL reconstruction is associated with meeting isokinetic extension strength return to sport criteria near completion of physical therapy and whether FNB affects 1-year or 2-year risk of ipsilateral ACL graft rupture or contralateral native ACL injury.
Methods
Three-hundred and sixty patients (n = 244 with FNB, n = 116 no FNB) underwent primary ACL reconstruction. All patients completed rehabilitation and underwent functional strength testing towards the end of knee rehabilitation (mean 5.6 months post-surgery). Association between FNB and isokinetic extension strength limb symmetry index (LSI) (goal LSI ≥ 90% for return to sport) as well as risk of recurrent ACL injury within first or second year after surgery was evaluated.
Results
Ipsilateral or contralateral ACL injury within 2 years occurred in 11.2% of patients with FNB and 5.7% without FNB (p = 0.01). Patients with FNB had higher incidence of ipsilateral graft rupture within the first year after surgery but no difference in graft rupture during the second. Two-year risk of contralateral ACL injury was similar in both groups. At the time of initial testing, patients who received FNB had lower fast isokinetic extension LSI versus patients without FNB and were less likely achieve a goal ≥ 90% LSI; slow extension LSI was unaffected.
Conclusion
Use of FNB at the time of primary ACL reconstruction can negatively affect achievement of isokinetic extension strength return to sport criteria. FNB increases risk of graft rupture within the first year after surgery but does not affect re-injury risk during the second. FNB may not be appropriate for use in patients already at high risk of ACL re-injury.
Level of evidence
III.
Similar content being viewed by others
References
Abdallah FW, Whelan DB, Chan VW, Prasad GA, Endersby RV, Theodoropolous J et al (2016) Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction. Anesthesiology 124:1053–1064
Christensen JE, Taylor NE, Hetzel SJ, Shepler JA, Scerpella TA (2017) Isokinetic strength deficit 6 months after adductor canal blockade for anterior cruciate ligament reconstruction. Orthop J Sports Med 5:2325967117736249
Cuvillon P, Ripart J, Lalourcey L, Veyrat E, L’Hermite J, Boisson C et al (2001) The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 93:1045–1049
Grevstad U, Jæger P, Sørensen JK, Gottschau B, Ilfeld B, Ballegaard M et al (2016) The effect of local anesthetic volume within the adductor canal on quadriceps femoris function evaluated by electromyography: a randomized, observer- and subject-blinded, placebo-controlled study in volunteers. Anesth Analg 123:493–500
Hirt D, Julia M, Herisson C (2011) Influence de l’anesthésie locorégionale sur la récupération musculaire après ligamentoplastie du genou. J Traumatol Sport 28:71–76
Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM (2005) Peripheral nerve block techniques for ambulatory surgery. Anesth Analg 101:1663–1676
Kline PW, Morgan KD, Johnson DL, Ireland ML, Noehren B (2015) Impaired quadriceps rate of torque development and knee mechanics after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 43:2553–2558
Krych A, Arutyunyan G, Kuzma S, Levy B, Dahm D, Stuart M (2015) Adverse effect of femoral nerve blockade on quadriceps strength and function after ACL reconstruction. J Knee Surg 28:83–88
Luo TD, Ashraf A, Dahm DL, Stuart MJ, McIntosh AL (2015) Femoral nerve block is associated with persistent strength deficits at 6 months after anterior cruciate ligament reconstruction in pediatric and adolescent patients. Am J Sports Med 43:331–336
Magnussen RA, Pottkotter K, Stasi SD, Paterno MV, Wordeman SC, Schmitt LC et al (2017) Femoral nerve block after anterior cruciate ligament reconstruction. J Knee Surg 30:323–328
Maldonado G, Greenland S (1993) Simulation study of confounder-selection strategies. Am J Epidemiol 138:923–936
McLean SG, Samorezov JE (2009) Fatigue-induced ACL injury risk stems from a degradation in central control. Med Sci Sports Exerc 41:1661–1672
Mickey RM, Greenland S (1989) The impact of confounder selection criteria on effect estimation. Am J Epidemiol 129:125–137
Okoroha KR, Khalil L, Jung EK, Keller RA, Marshall NE, Abouljoud M et al (2018) Single-shot femoral nerve block does not cause long-term strength and functional deficits following anterior cruciate ligament reconstruction. Arthroscopy 34:205–212
Palmieri RM, Weltman A, Edwards JE, Tom JA, Saliba EN, Mistry DJ et al (2005) Pre-synaptic modulation of quadriceps arthrogenic muscle inhibition. Knee Surg Sports Traumatol Arthrosc 13:370–376
Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21:948–957
Secrist ES, Freedman KB, Ciccotti MG, Mazur DW, Hammoud S (2016) Pain management after outpatient anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Am J Sports Med 44:2435–2447
Stebler K, Martin R, Kirkham KR, Küntzer T, Bathory I, Albrecht E (2017) Electrophysiological study of femoral nerve function after a continuous femoral nerve block for anterior cruciate ligament reconstruction: a randomized, controlled single-blind trial. Am J Sports Med 45:578–583
Swank KR, DiBartola AC, Everhart JS, Kaeding CC, Magnussen RA, Flanigan DC (2017) The effect of femoral nerve block on quadriceps strength in anterior cruciate ligament reconstruction: a systematic review. Arthroscopy 33:1082–1091.e1081
Urbach D, Nebelung W, Becker R, Awiszus F (2001) Effects of reconstruction of the anterior cruciate ligament on voluntary activation of quadriceps femoris a prospective twitch interpolation study. J Bone Joint Surg Br 83:1104–1110
Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD (2016) Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 44:1861–1876
Wright RW, Haas AK, Anderson J, Calabrese G, Cavanaugh J, Hewett TE et al (2015) Anterior cruciate ligament reconstruction rehabilitation: MOON guidelines. Sports Health 7:239–243
Funding
The authors received no funding for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
Approval was obtained from the Biomedical Institutional Review Board of The Ohio State University, Study No. 2016H0099.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Everhart, J.S., Hughes, L., Abouljoud, M.M. et al. Femoral nerve block at time of ACL reconstruction causes lasting quadriceps strength deficits and may increase short-term risk of re-injury. Knee Surg Sports Traumatol Arthrosc 28, 1894–1900 (2020). https://doi.org/10.1007/s00167-019-05628-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-019-05628-7