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Tomasz Poboży

Adductor Canal Block After ACL Reconstruction — Does It Add to Local Infiltration?

Autor:

Tomasz Poboży

Polish version: Blok kanału przywodzicieli po rekonstrukcji ACL — czy wnosi coś ponad infiltrację miejscową?

Does routinely adding an adductor canal block (ACB) to effective local infiltration analgesia (LIA) provide additional pain relief after anterior cruciate ligament (ACL) reconstruction? A double-blind randomised trial in The American Journal of Sports Medicine found no significant advantage over LIA alone during the first postoperative day.

Why does this study matter?

ACB is widely used after ACL reconstruction because it aims to reduce pain while relatively preserving quadriceps function. LIA is simpler to organise and can be performed by the surgical team without a separate block procedure. If combining the methods adds little benefit, this may matter for day-case care, anaesthetist time and costs. The findings nevertheless need to be interpreted within the trial’s design.

Research question and methods

Ojaghi and colleagues conducted a double-blind randomised controlled trial of 100 patients undergoing ACL reconstruction under general anaesthesia. Fifty patients were assigned to each group:

  • LIA plus sham procedure: local infiltration and a saline injection instead of an active ACB.
  • LIA plus ACB: local infiltration combined with an adductor canal block.

The primary outcome was opioid consumption during the first 24 postoperative hours. Other outcomes were pain on a visual analogue scale (VAS), ability to perform a straight-leg raise (SLR) at three hours, Quality of Recovery-15 (QoR-15) on the first day and Knee injury and Osteoarthritis Outcome Score (KOOS) at one week.

Main findings

  • No significant difference in opioid consumption over the first 24 hours: p = 0.109.
  • No significant difference in VAS pain at 24 hours: p = 0.0804.
  • No difference in SLR performance at three hours: p = 0.6711.
  • No difference in QoR-15 on the first day: p = 0.6486.
  • No difference in KOOS at one week: p = 0.9054.
  • Intraoperative opioid use also did not differ significantly: p = 0.127.

The public abstract does not provide effect sizes or confidence intervals for the primary outcome. Lack of statistical significance alone cannot establish how large or small the true clinical difference might be.

Clinical interpretation for an orthopaedic surgeon

Within the protocol studied, no measurable additional benefit from routinely adding ACB to LIA was demonstrated. This supports examining whether well-planned local infiltration may be sufficient as part of multimodal analgesia for some patients after standard ACL reconstruction.

However, failure to detect a difference is not proof of equivalence. The public abstract does not indicate a formal non-inferiority or equivalence design. A non-significant result in 100 patients does not exclude a small benefit that might matter in a particular subgroup.

Limitations

  • The study included 100 patients and one specific perioperative protocol.
  • The main analgesic assessment covered only the first 24 hours.
  • The public abstract does not report absolute opioid consumption, mean differences or confidence intervals, preventing precise assessment of effect size.
  • Patients underwent general anaesthesia; the findings should not automatically be generalised to every anaesthetic regimen, graft type or more complex combined procedure.
  • Individual postoperative pain risk, opioid tolerance and the rehabilitation plan may still influence regional analgesia choices.

Implications for practice and remaining uncertainty

The trial may encourage reconsideration of automatic ACB for every patient when effective LIA and multimodal analgesia are already used. This is particularly relevant to outpatient surgery, where simplicity and predictability of care matter.

It does not show that ACB is ineffective or should be removed from all ACL reconstruction protocols. The specific comparison was LIA plus ACB versus LIA without an active block. It does not resolve questions about patients at high risk of pain, other block techniques, different drug volumes or concentrations, or situations where LIA is not used.

References

Ojaghi R, Locke E, Elmi P, Pickell M. Adductor Canal Block and Local Anesthetic Versus Local Anesthetic Alone in ACL Reconstruction: A Double-Blind Randomized Controlled Trial. Am J Sports Med. Published online August 3, 2026. DOI: 10.1177/03635465261464409. PMID: 42544937. Trial registration: NCT04721119.

This summary is based solely on the public abstract and publication metadata.

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For Doctors and Physiotherapists · Research Updates, Literature and Evidence-Based Medicine

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

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