Association between anesthetic approach and clinical outcomes of ACL reconstruction: a retrospective cohort study.

BACKGROUND

Anterior cruciate ligament reconstruction (ACLr) is among the most common orthopedic procedures, however, large-scale studies analyzing regional anesthesia (RA) as an adjunct to general anesthesia (GA) are lacking.

METHODS

TriNetX was used to identify adults undergoing ACLr between January 2014 and January 2024. Patients were categorized as receiving GA (inhalational/intravenous anesthetics with neuromuscular blockers only), RA (local anesthetics for nerve/neuraxial blocks only), or combined anesthesia (general and regional agents). Outcomes were assessed over short-term (1-day to 1-month) and long-term (1-day to 1-year) intervals. Propensity score matching (1:1) balanced demographic and clinical covariates.

RESULTS

In the short-term, GA had increased revision ACLr (RR 2.00, p = 0.01), postoperative pain (RR 1.56, p < 0.01), and opioid dependence (RR 1.96, p < 0.01), but less knee stiffness (RR 0.49, p < 0.01) and physical therapy (PT) (RR 0.87, p < 0.01) than combined anesthesia. RA had higher postoperative pain (RR 1.44, p = 0.02) and opioid prescriptions (RR 1.16, p < 0.01), but less PT (RR 0.62, p < 0.01) than combined anesthesia. GA had less knee stiffness (RR 0.43, p < 0.01) and opioid prescriptions (RR 0.80, p < 0.01), but more PT (RR 1.38, p < 0.01) than RA.