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. 2023 Feb;31(2):487-494.
doi: 10.1007/s00167-022-07052-w. Epub 2022 Jul 30.

General, spinal or regional anaesthesia does not affect strength performance 6 months after ACL reconstruction

M Wenning  1   2 , M Mauch  3 , A H Heitner  4 , S Heinrich  5 , G N Sofack  6 , M Behrens  6 , R Ritzmann  4   7
Affiliations

General, spinal or regional anaesthesia does not affect strength performance 6 months after ACL reconstruction

M Wenning et al. Knee Surg Sports Traumatol Arthrosc. 2023 Feb.

Abstract

Purpose: The recovery of strength is a key element in successfully returning to sports after ACL reconstruction. The type of anaesthesia has been suspected an influential factor in the post-operative recovery of muscle function.

Methods: In this retrospective analysis, n = 442 consecutive patients undergoing primary isolated ACL reconstruction using a hamstring autograft were analysed by pre- and post-operative isokinetic tests in a single orthopaedic centre. These were subdivided into four cohorts: (1) general anaesthesia (n = 47), (2) general anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 37), (3) spinal anaesthesia (n = 169) and (4) spinal anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 185). Primary outcome was the change from pre- to post-operative isokinetic strength during knee extension and flexion.

Results: Using one-way ANOVA, there was no significant influence of the type of anaesthesia. The main effect of anaesthesia on change in extension forces was not significant, and effect sizes were very small (n.s.). Similarly, the main effect of anaesthesia on change in flexion forces was statistically not significant (n.s.).

Conclusions: The findings of this study support the interpretation that the type of anaesthesia has no significant effect on the ability to recover thigh muscle strength 6 months after isolated hamstring ACL reconstruction. With regard to the recovery of athletic performance and return-to-sports testing criteria, there is no reason to avoid regional anaesthesia.

Level of evidence: III.

Keywords: ACL reconstruction; Isokinetic strength; Perioperative anaesthesia; Return-to-sports.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Relative increase in knee extension and flexion strength across the groups subdivided between injured and non-injured legs (% of the preoperative values). GA general anaesthesia, GA + pFNB general anaesthesia with prolonged on-demand femoral nerve block, Sp spinal anaesthesia, Sp + pFNB spinal anaesthesia with prolonged on-demand femoral nerve block
Fig. 2
Fig. 2
a Distribution of LSI in knee extension strength across the groups. dashed line = 85% LSI, black line = summary of distribution pattern, stacks = % of cases (frequency) in each group according to LSI. GA general anaesthesia, GA + pFNB general anaesthesia with prolonged on-demand femoral nerve block, Spinal spinal anaesthesia, Spinal + pFNB spinal anaesthesia with prolonged on-demand femoral nerve block. b Distribution of LSI in knee flexion strength across the groups. Dashed line = 85% LSI, black line = summary of distribution pattern, stacks = % of cases (frequency) in each group according to LSI. GA general anaesthesia, GA + pFNB general anaesthesia with prolonged on-demand femoral nerve block, Spinal spinal anaesthesia, Spinal + pFNB spinal anaesthesia with prolonged on-demand femoral nerve block
See this image and copyright information in PMC

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