Authors: (Multicenter Adolescent ACL Registry Investigators)
BMJ Journals Regional Anesthesia & Pain Medicine
This multicenter prospective observational study investigated the relationship between regional anesthesia and postoperative functional recovery in adolescents undergoing anterior cruciate ligament (ACL) reconstruction. While peripheral nerve blocks are widely used for perioperative analgesia, their potential effect on longer-term function and rehabilitation outcomes in youth athletes remains uncertain.
Fifteen institutions contributed to a registry of 519 patients aged 12–17 years undergoing ACL reconstruction. Functional recovery was evaluated using the Lysholm Knee Score (0–100; higher indicates better function) at postoperative day 1, day 3, week 6, and month 6, and by the Limb Symmetry Index (LSI) (ratio of operative to non-operative limb performance) at 6–9 months, where values ≥ 90% denote readiness to return to sport.
Lysholm scores improved steadily in all groups. At week 6, patients receiving combined anterior and posterior nerve blocks had slightly higher median Lysholm scores (83 vs 78; P = 0.041) compared to those with no block or anterior block alone, though differences resolved by six months when most patients achieved good-to-excellent function. Younger adolescents (12–15 years) showed faster recovery (median 89 vs 86, P < 0.05), while females had lower scores than males at several intervals. High early postoperative pain (numeric score ≥ 7) predicted slower recovery, whereas positive temperament and lower preoperative anxiety/depression scores were associated with better outcomes. By 6–9 months, 67% achieved an LSI ≥ 90%, indicating readiness for sport. Nerve block type did not significantly affect LSI achievement.
The findings show that regional anesthesia does not hinder—and may transiently support—functional recovery after adolescent ACL reconstruction. Psychological and demographic factors were stronger predictors of postoperative performance than anesthetic technique.
What You Should Know
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Regional anesthesia (single or dual block) does not impair functional or sport-readiness recovery in adolescent ACL surgery.
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Combined anterior + posterior blocks yielded slightly better short-term function, but no long-term difference.
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Recovery trajectory was mainly influenced by age, sex, and psychological resilience.
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Early postoperative pain control remains critical for promoting early rehabilitation success.
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