Magnussen Robert A, Pottkotter Kristy, Stasi Stephanie Di, Paterno Mark V, Wordeman Samuel C, Schmitt Laura C, Flanigan David C, Kaeding Christopher C, Hewett Timothy E
Department of Orthopaedics, The Ohio State University, Columbus, Ohio.
OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio.
J Knee Surg. 2017 May;30(4):323-328. doi: 10.1055/s-0036-1584538. Epub 2016 Jun 30.
Femoral nerve block (FNB) has been proposed for pain control following anterior cruciate ligament (ACL) reconstruction. Although numerous studies have assessed the efficacy of FNBs, there has been little to no research into the effect of such blocks on postoperative strength and patient-reported outcomes. We hypothesized that performance of an FNB would result in decreased quadriceps strength and poorer patient-reported outcome scores within the first 6 months following ACL reconstruction. A total of 30 patients scheduled to undergo hamstring autograft ACL reconstruction following an acute ACL injury were randomized to a single-shot FNB group or a control group. Preoperatively, patients completed a Knee Injury and Osteoarthritis Outcome Score (KOOS) and isokinetic quadriceps strength testing at 60 degrees/second. At 6 weeks postoperative, 29 of 30 patients completed a KOOS and isometric quadriceps strength testing at 90 degrees. At 6 months postoperative, 23 of 30 patients completed a KOOS and isokinetic strength testing. Quadriceps femoris strength limb symmetry indices (QF-LSI) were calculated at all time points. Repeated measures analysis of variance (ANOVA) models were then utilized to model the effect of FNB and time on QF-LSI as well as KOOS subscales for activities of daily living, pain, and symptoms. QF-LSI and all KOOS subscales demonstrated improvement with time following ACL reconstruction. Repeated measures ANOVA demonstrated that patients who underwent FNB had a mean QF-LSI that was 13.4% lower than the control group ( = 0.005) and poorer KOOS symptoms subscale scores (10.4 point difference, = 0.032) at 6 weeks postoperative compared with controls. At 6 months postoperative, no differences were noted in QF-LSI or any of the KOOS subscales based on block status. FNB resulted in decreased strength and poorer KOOS symptom subscale score at 6 weeks following ACL reconstruction compared with controls. These differences resolved by 6 months postoperative. The long-term effect of delayed quadriceps recovery on movement patterns and functional outcome remains unknown and requires further study. The study is a randomized controlled trial with level of evidence 1.
股神经阻滞（FNB）已被用于前交叉韧带（ACL）重建术后的疼痛控制。尽管众多研究评估了FNB的疗效，但对于此类阻滞对术后力量和患者报告结局的影响，几乎没有研究。我们假设，在ACL重建后的前6个月内，进行FNB会导致股四头肌力量下降以及患者报告的结局评分更差。共有30例因急性ACL损伤计划接受腘绳肌自体移植ACL重建的患者被随机分为单次FNB组或对照组。术前，患者完成膝关节损伤和骨关节炎结局评分（KOOS）以及60度/秒的等速股四头肌力量测试。术后6周，30例患者中的29例完成了KOOS以及90度的等长股四头肌力量测试。术后6个月，30例患者中的23例完成了KOOS以及等速力量测试。在所有时间点计算股四头肌力量肢体对称指数（QF-LSI）。然后利用重复测量方差分析（ANOVA）模型来模拟FNB和时间对QF-LSI以及KOOS日常生活活动、疼痛和症状子量表的影响。ACL重建后，QF-LSI和所有KOOS子量表均随时间改善。重复测量ANOVA表明，与对照组相比，接受FNB的患者术后6周的平均QF-LSI低13.4%（P = 0.005），KOOS症状子量表评分更差（相差10.4分，P = 0.032）。术后6个月，基于阻滞状态，QF-LSI或任何KOOS子量表均未发现差异。与对照组相比，FNB导致ACL重建术后6周力量下降且KOOS症状子量表评分更差。这些差异在术后6个月时消失。股四头肌恢复延迟对运动模式和功能结局的长期影响尚不清楚，需要进一步研究。该研究是一项证据等级为1级的随机对照试验。
