The purpose of this study was to determine if quadriceps strength and functional outcomes were similar at 6 months following anterior cruciate ligament [ACL] reconstruction in patients receiving a continuous 48-hour femoral nerve blockade for postoperative analgesia (FNB group) versus patients with no FNB (control group). A retrospective cohort was designed including athletes who underwent primary ACL reconstruction with patellar tendon autograft between 2005 and 2010 at our institution with identical rehabilitation protocols. The FNB group included 96 patients with an average age of 21 years and the control group included 100 patients with an average age of 20 years. At 6 months following ACL reconstruction, isokinetic strength (slow and fast activation) and functional tests including vertical jump, single hop, triple hop, and return to sport were analyzed with an α value < 0.05 as significant. Multivariate regression models were used to compare these outcomes between the FNB and control groups after adjusting for gender and competitive athlete status. At 6 months, fast extension isokinetic strength was inferior in the FNB group (78 vs. 85%; p < 0.01). After adjusting for gender and competitive athlete status, fast (p = 0.002) and slow extension strength (p = 0.01), vertical jump (p = 0.03) and single jump (p = 0.02) were also inferior in the FNB group. There were no significant differences in full return to sport between the two groups (86% at 7.5 months in the FNB group vs. 93% at 7.3 months in the control group). In this retrospective comparative study, the hypothesis that patients treated with continuous FNB for postoperative analgesia following ACL reconstruction with patellar tendon autograft will have inferior knee extension (quadriceps) strength and function at 6 months follow-up was affirmed. However, no differences were observed in return to sport, bringing into question whether these statistical differences translate into meaningful clinical consequences after ACL reconstruction. The level of evidence was level III, retrospective case-control series.

Background: It is unclear whether patients can be taken off suppressive antibiotics with infected retained instrumentation. This study aimed to retrospectively analyze the perioperative course and antibiotic regimen that led to the clinical intervention of patients with infected spinal instrumentation.Methods: Consecutive adult patients with spine instrumentation who suffered surgical site infections (SSI) requiring debridement were retrospectively analyzed. The patients were grouped into 4 cohorts based on their clinical intervention: removal of instrumentation, reinstrumentation, retention of instrumentation with continued antibiotic suppression, and retention of instrumentation with no antibiotic suppression. Patient factors, infection factors, debridement, and antibiosis were compared.Results: Of the 67 patients with SSI after spine surgery and instrumentation, 19 (28%) had their instrumentation removed, 6 (9%) had their instrumentation exchanged, 25 (37%) had their instrumentation retained and were on antibiotic suppression, and 17 (25%) had their instrumentation retained without any suppression. Those who had their instrumentation removed had a later presentation of their infection averaging 85 days (range 6-280 days) postoperatively. There was an earlier presentation for those who retained their implants, with suppression averaging 19 days (range 9-39) and no suppression averaging 29 days (range 6-90 days) post operatively (P , .001).Conclusions: None of the patients with retained instrumentation without suppression had recurrence of infections after long-term follow-up. Lifelong antibiotic suppression may not be required with SSI that present early after early aggressive debridement. Patients with infections detected later are difficult to treat without removal of their original instrumentation.Clinical Relevance: This study presents the outcomes of surgical and antibiotic factors in patients with infected spinal instrumentation.

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