No abstract

Background:Peripheral nerve blocks, particularly femoral nerve blocks (FNBs), are commonly performed for anterior cruciate ligament (ACL) reconstruction. However, associated quadriceps muscle weakness after FNBs is well described and may occur for up to 6 months postoperatively. The adductor canal block (ACB) has emerged as a viable alternative to the FNB, theoretically causing less quadriceps weakness during the immediate postoperative period, as it bypasses the majority of the motor fibers of the femoral nerve that branch off proximal to the adductor canal.Purpose/Hypothesis:This study sought to identify if a difference in quadriceps strength exists after an ACB or FNB for ACL reconstruction beyond the immediate postoperative period. Beyond the immediate postoperative period, we anticipated no difference in quadriceps strength between patients who received ACBs or FNBs for ACL reconstruction.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 102 patients undergoing primary ACL reconstruction using a variety of graft types were enrolled between November 2015 and April 2016. All patients were randomized to receive an ACB or FNB before surgery, and the surgeon was blinded to the block type. All patients underwent aggressive rehabilitation without functional bracing postoperatively. The time to the first straight-leg raise was reported by the patient. Isokinetic strength testing was performed at 3 and 6 months postoperatively.Results:Data for 73 patients were analyzed. There was no significant difference in patient demographics of age, body mass index, sex, or tourniquet time between the FNB (n = 35) and ACB (n = 38) groups. The mean time to the first straight-leg raise was similar, at 13.1 ± 1.0 hours for the FNB group and 15.5 ± 1.2 hours for the ACB group (P = .134). The mean extension torque at 60 deg/s increased significantly for both the ACB (53.7% ± 3.4% to 68.3% ± 2.9%; P = .008) and the FNB (53.3% ± 3.3% to 68.5% ± 4.1%; P = .006) groups from 3 to 6 months postoperatively. There was also no significant difference in mean extension torque at 60 deg/s or 180 deg/s between the FNB and ACB groups at 3 and 6 months. There were no significant differences in postoperative complications (infection, arthrofibrosis, retear) between groups.Conclusion:Although prior studies have shown immediate postoperative benefits of ACBs compared with FNBs, with a faster return of quadriceps strength, in the current study there was no statistically or clinically significant difference in quadriceps strength at 3 and 6 months postoperatively in patients who received ACBs or FNBs for ACL reconstruction.

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

This study adds to the evolving literature supporting biceps tenodesis as a viable treatment for type II and IV SLAP lesions. Patient age had no effect on the outcomes. Based on these results, biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears.

Background:In the currently published literature, a higher risk for developing arthrofibrosis after anterior cruciate ligament (ACL) reconstruction has been reported for female patients, adolescents, early surgery or concomitant procedures, and the use of a patellar tendon autograft. There is a lack of evidence regarding other graft choices or factors.Hypothesis:Multiple risk factors will play a significant role in the development of arthrofibrosis after ACL reconstruction. Specifically, we hypothesized that the risk of manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA) would be affected by graft choice and patient demographic factors.Study Design:Case-control study; Level of evidence, 3.Methods:The charts of all patients who underwent ACL reconstruction over a 10-year period at a single academic institution were queried from an electronic medical record database and reviewed at a minimum of 6 months after ACL reconstruction, with the collection of demographic and surgical data. The relative risk for undergoing MUA and/or LOA was calculated for each analyzed risk factor.Results:A total of 2424 ACL reconstructions were included, with a chart review at a mean of 56.7 months after surgery (range, 7.6-124.0 months). The rate of MUA and/or LOA for arthrofibrosis was 4.5%. A statistically significantly increased relative risk was found for infection (5.45), hematoma requiring evacuation (3.55), ACL reconstruction with meniscal repair (2.83), use of a quadriceps tendon autograft (2.68), age <18 years (2.39), multiple concomitant procedures (1.69), contact injury (1.62), female sex (1.60), and surgery within 28 days of injury (1.53), and a statistically significantly decreased relative risk was found for revision ACL reconstruction (0.30), age >25 years (0.34), and use of a tibialis anterior allograft (0.36). In the multivariate regression model, the use of a quadriceps tendon autograft (P = .00007), infection (P = .00126), and concomitant meniscal repair (P = .00194) were independent risk factors, whereas revision ACL reconstruction (P = .0024) was an independent protective factor.Conclusion:Graft type, infection, concomitant meniscal repair, and primary reconstruction are significant risk factors for undergoing MUA or LOA after ACL reconstruction.