AJSM - 2026-08-03 - Journal Article
Adductor Canal Block and Local Anesthetic Versus Local Anesthetic Alone in ACL Reconstruction: A Double-Blind Randomized Controlled Trial.
Ojaghi R, Locke E, Elmi P, Pickell M
Topics
Key Takeaway
Adding ACB to LIA in ACLR did not reduce 24-hour opioid consumption (P=.109) or improve any secondary outcome versus LIA alone in this double-blind RCT of 100 patients.
Summary Depth
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Summary
This double-blind RCT compared LIA+ACB versus LIA+sham in 100 patients undergoing ACLR under general anesthesia, with 24-hour opioid consumption as the primary endpoint. No significant differences were found in opioid consumption (P=.109), VAS pain scores at 24 hours (P=.0804), SLR performance at 3 hours (P=.6711), QoR-15 on POD1 (P=.6486), or KOOS at 1 week (P=.9054). LIA alone appears sufficient for routine perioperative analgesia in ACLR, making routine ACB addition unnecessary.
Key Limitation
The study does not report graft type distribution, and hamstring versus quadriceps tendon harvest introduces differential donor-site pain that could confound opioid consumption data and mask a subgroup benefit of ACB.
Original Abstract
BACKGROUND
Effective postoperative analgesia is crucial for early recovery after anterior cruciate ligament reconstruction (ACLR). Local infiltration analgesia (LIA) and adductor canal block (ACB) are common regional techniques, but their combined efficacy remains unclear.
PURPOSE
To compare the effectiveness of LIA alone versus LIA combined with ACB in patients undergoing ACLR, with primary outcomes including postoperative opioid consumption and quadriceps function.
STUDY DESIGN
Randomized controlled trial; Level of evidence, 1.
METHODS
A double-blind randomized controlled trial enrolled 100 patients undergoing ACLR under general anesthesia. Patients were randomized into 2 groups: LIA + sham (saline injection) (n = 50) and LIA + ACB (n = 50). The primary outcome was postoperative opioid consumption in the first 24 hours. Secondary outcomes included visual analog scale (VAS) pain score, quadriceps function assessed by straight leg raise (SLR) at 3 hours, Quality of Recovery-15 (QoR-15) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1 week. Statistical analysis was performed using t tests and chi-square tests with a P value <.05 considered significant.
RESULTS
There was no significant difference in 24-hour opioid consumption between the LIA + ACB and LIA-only groups ( P = .109). Similarly, VAS pain scores at 24 hours postoperatively showed no significant differences between the groups ( P = .0804). Early functional recovery, assessed by SLR performance at 3 hours, was equivalent between groups ( P = .6711). Additionally, QoR-15 scores on postoperative day 1 and KOOS values at 1 week demonstrated no significant differences ( P = .6486 and P = .9054, respectively). Intraoperative opioid consumption was not different between the groups ( P = .127).
CONCLUSION
These findings indicate that the addition of ACB to LIA does not yield postoperative analgesic in ACLR. Consequently, LIA alone suffices for routine ACLR, potentially enabling clinicians to optimize perioperative workflows without incurring the additional time, financial burden, and resources associated with routine ACB administration.
TRIAL REGISTRATION
ClinicalTrials.gov; NCT04721119.