Regional anesthesia and functional outcomes after anterior cruciate ligament reconstruction surgery in adolescent patients: Society of Pediatric Anesthesia Improvement Network (SPAIN)

1. Regional anesthesia, including combined anterior and posterior blocks, did not impair 6-month functional recovery after adolescent ACL reconstruction.

2. Patient age, sex, early pain control, and preoperative psychological health were stronger determinants of recovery than block type.

Evidence Rating Level: 2 (Good)

Adolescent anterior cruciate ligament reconstruction (ACLR) frequently incorporates regional anesthesia, but its effect on functional recovery is unclear. This multicenter prospective registry from 15 SPAIN institutions enrolled 519 patients aged 12–17 undergoing ACLR to examine whether peripheral nerve block (PNB) use or type influenced recovery. Patients completed Lysholm Knee Scores on postoperative day (POD) 1, POD 3, week 6 and month 6, and a single-hop Limb Symmetry Index (LSI) at 6–9 months. Lysholm scores improved in all groups; at week 6, those receiving combined anterior and posterior blocks had slightly higher function than those with no or anterior-only block (median 83 vs 78; p=0.041), but by month 6, scores were comparable and in the good–excellent range. Two-thirds (67%) attained LSI ≥90%, indicating readiness for return to sport, and PNB type was not associated with LSI. Younger age, female sex, higher early postoperative pain, and preoperative anxiety/depression predicted lower short-term functional scores. Recovery appeared more strongly driven by developmental and psychological factors than by anesthetic technique. These findings support counseling families that block choice should prioritize analgesia without concern for delayed rehabilitation. Further research should refine catheter versus single-shot approaches and address high early pain scores in this population better.

Click here to read this study in Regional Anesthesia & Pain Medicine

Image: PD

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