Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction

Robert A. Magnussen, Kristy Pottkotter, Stephanie Di Stasi, Mark V. Paterno, Samuel C. Wordeman, Laura C. Schmitt, David C. Flanigan, Christopher C. Kaeding, Timothy Hewett

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous studies have assessed the efficacy of FNBs, there has been little to no research into the effect of such blocks on postoperative strength and patient-reported outcomes. We hypothesized that performance of an FNB would result in decreased quadriceps strength and poorer patient-reported outcome scores within the first 6 months following ACL reconstruction. A total of 30 patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single-shot FNB group or a control group. Preoperatively, patients completed a Knee Injury and Osteoarthritis Outcome Score (KOOS) and isokinetic quadriceps strength testing at 60 degrees/second. At 6 weeks postoperative, 29 of 30 patients completed a KOOS and isometric quadriceps strength testing at 90 degrees. At 6 months postoperative, 23 of 30 patients completed a KOOS and isokinetic strength testing. Quadriceps femoris strength limb symmetry indices (QF-LSI) were calculated at all time points. Repeated measures analysis of variance (ANOVA) models were then utilized to model the effect of FNB and time on QF-LSI as well as KOOS subscales for activities of daily living, pain, and symptoms. QF-LSI and all KOOS subscales demonstrated improvement with time following ACL reconstruction. Repeated measures ANOVA demonstrated that patients who underwent FNB had a mean QF-LSI that was 13.4% lower than the control group (p = 0.005) and poorer KOOS symptoms subscale scores (10.4 point difference, p = 0.032) at 6 weeks postoperative compared with controls. At 6 months postoperative, no differences were noted in QF-LSI or any of the KOOS subscales based on block status. FNB resulted in decreased strength and poorer KOOS symptom subscale score at 6 weeks following ACL reconstruction compared with controls. These differences resolved by 6 months postoperative. The long-term effect of delayed quadriceps recovery on movement patterns and functional outcome remains unknown and requires further study. The study is a randomized controlled trial with level of evidence 1.

Original languageEnglish (US)
JournalJournal of Knee Surgery
DOIs
StateAccepted/In press - Oct 23 2015

Fingerprint

Femoral Nerve
Knee Injuries
Anterior Cruciate Ligament Reconstruction
Nerve Block
Knee Osteoarthritis
Quadriceps Muscle
Extremities
Analysis of Variance
Pain
Control Groups
Autografts
Activities of Daily Living
Randomized Controlled Trials

Keywords

  • anterior cruciate ligament reconstruction
  • femoral nerve block
  • patient-reported outcomes
  • strength testing

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Magnussen, R. A., Pottkotter, K., Stasi, S. D., Paterno, M. V., Wordeman, S. C., Schmitt, L. C., ... Hewett, T. (Accepted/In press). Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction. Journal of Knee Surgery. https://doi.org/10.1055/s-0036-1584538

Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction. / Magnussen, Robert A.; Pottkotter, Kristy; Stasi, Stephanie Di; Paterno, Mark V.; Wordeman, Samuel C.; Schmitt, Laura C.; Flanigan, David C.; Kaeding, Christopher C.; Hewett, Timothy.

In: Journal of Knee Surgery, 23.10.2015.

Research output: Contribution to journalArticle

Magnussen, RA, Pottkotter, K, Stasi, SD, Paterno, MV, Wordeman, SC, Schmitt, LC, Flanigan, DC, Kaeding, CC & Hewett, T 2015, 'Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction', Journal of Knee Surgery. https://doi.org/10.1055/s-0036-1584538
Magnussen RA, Pottkotter K, Stasi SD, Paterno MV, Wordeman SC, Schmitt LC et al. Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction. Journal of Knee Surgery. 2015 Oct 23. https://doi.org/10.1055/s-0036-1584538
Magnussen, Robert A. ; Pottkotter, Kristy ; Stasi, Stephanie Di ; Paterno, Mark V. ; Wordeman, Samuel C. ; Schmitt, Laura C. ; Flanigan, David C. ; Kaeding, Christopher C. ; Hewett, Timothy. / Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction. In: Journal of Knee Surgery. 2015.
@article{eb63f55af29841cea4e859fed17e37a2,
title = "Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction",
abstract = "Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous studies have assessed the efficacy of FNBs, there has been little to no research into the effect of such blocks on postoperative strength and patient-reported outcomes. We hypothesized that performance of an FNB would result in decreased quadriceps strength and poorer patient-reported outcome scores within the first 6 months following ACL reconstruction. A total of 30 patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single-shot FNB group or a control group. Preoperatively, patients completed a Knee Injury and Osteoarthritis Outcome Score (KOOS) and isokinetic quadriceps strength testing at 60 degrees/second. At 6 weeks postoperative, 29 of 30 patients completed a KOOS and isometric quadriceps strength testing at 90 degrees. At 6 months postoperative, 23 of 30 patients completed a KOOS and isokinetic strength testing. Quadriceps femoris strength limb symmetry indices (QF-LSI) were calculated at all time points. Repeated measures analysis of variance (ANOVA) models were then utilized to model the effect of FNB and time on QF-LSI as well as KOOS subscales for activities of daily living, pain, and symptoms. QF-LSI and all KOOS subscales demonstrated improvement with time following ACL reconstruction. Repeated measures ANOVA demonstrated that patients who underwent FNB had a mean QF-LSI that was 13.4{\%} lower than the control group (p = 0.005) and poorer KOOS symptoms subscale scores (10.4 point difference, p = 0.032) at 6 weeks postoperative compared with controls. At 6 months postoperative, no differences were noted in QF-LSI or any of the KOOS subscales based on block status. FNB resulted in decreased strength and poorer KOOS symptom subscale score at 6 weeks following ACL reconstruction compared with controls. These differences resolved by 6 months postoperative. The long-term effect of delayed quadriceps recovery on movement patterns and functional outcome remains unknown and requires further study. The study is a randomized controlled trial with level of evidence 1.",
keywords = "anterior cruciate ligament reconstruction, femoral nerve block, patient-reported outcomes, strength testing",
author = "Magnussen, {Robert A.} and Kristy Pottkotter and Stasi, {Stephanie Di} and Paterno, {Mark V.} and Wordeman, {Samuel C.} and Schmitt, {Laura C.} and Flanigan, {David C.} and Kaeding, {Christopher C.} and Timothy Hewett",
year = "2015",
month = "10",
day = "23",
doi = "10.1055/s-0036-1584538",
language = "English (US)",
journal = "Journal of Knee Surgery",
issn = "1538-8506",
publisher = "Thieme Medical Publishers",

}

TY - JOUR

T1 - Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction

AU - Magnussen, Robert A.

AU - Pottkotter, Kristy

AU - Stasi, Stephanie Di

AU - Paterno, Mark V.

AU - Wordeman, Samuel C.

AU - Schmitt, Laura C.

AU - Flanigan, David C.

AU - Kaeding, Christopher C.

AU - Hewett, Timothy

PY - 2015/10/23

Y1 - 2015/10/23

N2 - Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous studies have assessed the efficacy of FNBs, there has been little to no research into the effect of such blocks on postoperative strength and patient-reported outcomes. We hypothesized that performance of an FNB would result in decreased quadriceps strength and poorer patient-reported outcome scores within the first 6 months following ACL reconstruction. A total of 30 patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single-shot FNB group or a control group. Preoperatively, patients completed a Knee Injury and Osteoarthritis Outcome Score (KOOS) and isokinetic quadriceps strength testing at 60 degrees/second. At 6 weeks postoperative, 29 of 30 patients completed a KOOS and isometric quadriceps strength testing at 90 degrees. At 6 months postoperative, 23 of 30 patients completed a KOOS and isokinetic strength testing. Quadriceps femoris strength limb symmetry indices (QF-LSI) were calculated at all time points. Repeated measures analysis of variance (ANOVA) models were then utilized to model the effect of FNB and time on QF-LSI as well as KOOS subscales for activities of daily living, pain, and symptoms. QF-LSI and all KOOS subscales demonstrated improvement with time following ACL reconstruction. Repeated measures ANOVA demonstrated that patients who underwent FNB had a mean QF-LSI that was 13.4% lower than the control group (p = 0.005) and poorer KOOS symptoms subscale scores (10.4 point difference, p = 0.032) at 6 weeks postoperative compared with controls. At 6 months postoperative, no differences were noted in QF-LSI or any of the KOOS subscales based on block status. FNB resulted in decreased strength and poorer KOOS symptom subscale score at 6 weeks following ACL reconstruction compared with controls. These differences resolved by 6 months postoperative. The long-term effect of delayed quadriceps recovery on movement patterns and functional outcome remains unknown and requires further study. The study is a randomized controlled trial with level of evidence 1.

AB - Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous studies have assessed the efficacy of FNBs, there has been little to no research into the effect of such blocks on postoperative strength and patient-reported outcomes. We hypothesized that performance of an FNB would result in decreased quadriceps strength and poorer patient-reported outcome scores within the first 6 months following ACL reconstruction. A total of 30 patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single-shot FNB group or a control group. Preoperatively, patients completed a Knee Injury and Osteoarthritis Outcome Score (KOOS) and isokinetic quadriceps strength testing at 60 degrees/second. At 6 weeks postoperative, 29 of 30 patients completed a KOOS and isometric quadriceps strength testing at 90 degrees. At 6 months postoperative, 23 of 30 patients completed a KOOS and isokinetic strength testing. Quadriceps femoris strength limb symmetry indices (QF-LSI) were calculated at all time points. Repeated measures analysis of variance (ANOVA) models were then utilized to model the effect of FNB and time on QF-LSI as well as KOOS subscales for activities of daily living, pain, and symptoms. QF-LSI and all KOOS subscales demonstrated improvement with time following ACL reconstruction. Repeated measures ANOVA demonstrated that patients who underwent FNB had a mean QF-LSI that was 13.4% lower than the control group (p = 0.005) and poorer KOOS symptoms subscale scores (10.4 point difference, p = 0.032) at 6 weeks postoperative compared with controls. At 6 months postoperative, no differences were noted in QF-LSI or any of the KOOS subscales based on block status. FNB resulted in decreased strength and poorer KOOS symptom subscale score at 6 weeks following ACL reconstruction compared with controls. These differences resolved by 6 months postoperative. The long-term effect of delayed quadriceps recovery on movement patterns and functional outcome remains unknown and requires further study. The study is a randomized controlled trial with level of evidence 1.

KW - anterior cruciate ligament reconstruction

KW - femoral nerve block

KW - patient-reported outcomes

KW - strength testing

UR - http://www.scopus.com/inward/record.url?scp=84976877635&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84976877635&partnerID=8YFLogxK

U2 - 10.1055/s-0036-1584538

DO - 10.1055/s-0036-1584538

M3 - Article

C2 - 27362929

AN - SCOPUS:84976877635

JO - Journal of Knee Surgery

JF - Journal of Knee Surgery

SN - 1538-8506

ER -