TOPLINE:

Regional anesthesia did not impair functional recovery in adolescents who underwent anterior cruciate ligament reconstruction surgery, with most patients achieving good functional outcomes by 6 months. Younger age, female sex, and negative temperament were linked to poorer recovery at week 6 and month 6.

METHODOLOGY:

• Researchers conducted a prospective observational study to assess the impact of peripheral nerve blocks on functional recovery in adolescents aged 12-17.5 years who underwent anterior cruciate ligament reconstruction.
• Functional recovery was assessed at various postoperative intervals using the Lysholm score — a patient-reported measure for functional recovery after knee surgeries — and the limb symmetry index, assessed using the single hop test. Data collection included preoperative psychological assessments using standardized tools such as the Revised Children’s Anxiety and Depression Scale and postoperative pain scores, use of opioids or analgesics, and leg neurologic symptoms.
• A total of 519 patients were enrolled from 15 sites. Self-reported Lysholm scores were provided by 253 patients on postoperative day 1, 274 on day 3, 285 at 6 weeks, and 196 at 6 months. The single hop test score was available for 125 patients (62.9% girls) at 6-9 months.

TAKEAWAY:

• Patients who received anterior or posterior nerve blocks had higher Lysholm scores at postoperative week 6 than those who received no nerve block or anterior-only blocks (P = .041).
• Patients aged 12 years to less than 16 years reported higher Lysholm scores than older patients from postoperative day 3 up to 6 months (P < .05 for all). Girls reported lower Lysholm scores than boys on postoperative day 1 (P = .038), week 6 (P < .001), and month 6 (P < .001).
• Among patients with limb symmetry index assessments, 67% achieved a score of > 90%. At 6-9 months, patients aged 12 years to less than 16 years vs those aged 16 years or older had higher odds of having a limb symmetry index score of < 90% (odds ratio, 2.54; P = .03).
• High early postoperative pain scores (≥ 7) were linked to lower function through week 6, whereas positive temperament and lower anxiety scores predicted better outcomes.

IN PRACTICE:

The findings support the continued use of peripheral nerve blocks “as part of a multimodal analgesia strategy in the perioperative period,” the authors of the study wrote, and “support the potential value of incorporating psychological assessment and support into the perioperative care of patients undergoing” anterior cruciate ligament reconstruction. These approaches include “child life services or behavioral coaching, as they could impact recovery and long-term outcomes,” they added.

SOURCE:

The study was led by Tessa Mandler, of the Department of Anesthesiology, Children’s Hospital Colorado, Aurora, Colorado. It was published online on October 29, 2025, in Regional Anesthesia & Pain Medicine.

LIMITATIONS:

The multisite design introduced variability in perioperative practices across sites, which could not be fully controlled. Not all participants had data available for the limb symmetry index and single hop tests. Variations in testing protocols, such as warm-up routines and measurement tools, may have introduced inconsistencies.

DISCLOSURES:

No specific funding was reported for this study. No relevant conflicts of interest were disclosed by the authors of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.