Outcome comparison of femoral nerve block and adductor canal block during anterior cruciate ligament reconstruction: adductor canal block may cause an unexpected decrease in knee flexor strength at 6 months postoperatively

• Published in: Archives of orthopaedic and trauma surgery 2023-10, Vol.143 (10), p.6305-6313
• Main Authors: Sengoku, Takuya, Nakase, Junsuke, Mizuno, Yushin, Yoshimizu, Rikuto, Kanayama, Tomoyuki, Yanatori, Yusuke, Tsuchiya, Hiroyuki
• Format: Article
• Language: English
• Subjects: Arthroscopy and Sports Medicine; Knee; Medicine; Medicine & Public Health; Orthopedics
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-023-04980-1

Introduction Peripheral nerve blocks are frequently used in anterior cruciate ligament (ACL) reconstruction. While femoral nerve block (FNB) has been associated with knee extensor strength reduction in the early postoperative period, no consistent view of knee extensor strength several months after ACL reconstruction exists. This study aimed to compare the impact of intraoperative FNB and adductor canal block (ACB) during ACL reconstruction on knee extensor strength at 3 and 6 months postoperatively. Materials and methods This retrospective study included 108 patients divided into FNB (70 patients) and ACB (38 patients) groups based on their postoperative pain management methods. Knee joint extensor and flexor strength were measured at 3 and 6 months postoperatively, using BIODEX at angular velocities of 60°/s and 180°/s. From these results, peak torque, limb symmetry index (LSI), peak knee extensor torque (time to peak torque and angle of peak torque), hamstrings-to-quadriceps (HQ) ratio, and amount of work were computed for two-group comparison. Results There were no statistically significant differences in peak torque, LSI of knee extensor strength, HQ ratio, and amount of work between the two groups. However, maximum knee extension torque at 60°/s occurred significantly later in the FNB than in the ACB group at 3 months postoperatively. Additionally, the LSI of the knee flexor at 6 months postoperatively was significantly lower in the ACB group. Conclusions In ACL reconstruction, FNB may delay the time to peak torque for knee extension at 3 months postoperatively, which is likely to improve over the treatment course. In contrast, ACB may result in unexpected loss of knee flexor strength at 6 months postoperatively and should be considered with caution. Level of evidence Level III.