Purpose
To systematically review randomized controlled trials (RCTs) evaluating various pain
control interventions after anterior cruciate ligament reconstruction (ACLR) to determine
the best-available evidence in managing postoperative pain and to optimize patient
outcomes.
Methods
A systematic review of the literature was performed based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A study was
included if it was an RCT evaluating an intervention to reduce postoperative pain
acutely after ACLR in one of the following areas: (1) nerve blocks, (2) nerve block
adjuncts, (3) intra-articular injections, (4) oral medications, (5) intravenous medications,
(6) tranexamic acid, and (7) compressive stockings and cryotherapy. Quantitative and
qualitative statistics were carried out, and network meta-analysis was performed where
applicable.
Results
Overall, 74 RCTs were included. Across 34 studies, nerve blocks were found to significantly
reduce postoperative pain and opioid use, but there was no significant difference
among the various nerve blocks in the network meta-analysis. Intra-articular injections
consisting of bupivacaine and an adjunct were found to reduce reported postoperative
pain scores up to 12 hours after ACLR, with significantly lower postoperative opioid
use.
Conclusions
Nerve blocks and regional anesthesia are the mainstay treatment of postoperative pain
after ACLR, with the commonly used nerve blocks being equally efficacious. Intra-articular
injections consisting of bupivacaine and an adjunct were found to reduce reported
postoperative pain scores up to 12 hours after ACLR, with significantly lower postoperative
opioid use. There was promising evidence for the use of some oral and intravenous
medications, tranexamic acid, and nerve block adjuncts, as well as cryotherapy, to
control pain and reduce postoperative opioid use.
Level of Evidence
Level II, systematic review and meta-analysis of RCTs.
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Article info
Publication history
Published online: January 27, 2021
Accepted:
January 5,
2021
Received:
September 9,
2020
Footnotes
The authors report the following potential conflicts of interest or sources of funding: M.A. receives grant support from Arthrex and Concours, outside the submitted work. E.J.S. receives grant support from Arthrex, Cartiheal, Fidia, and Organogenesis and receives personal fees from Arthrex, Flexion Therapeutics, JRF, Organogenesis, Smith & Nephew, Subchondral Solutions, and Vericel, outside the submitted work. K.A.C. receives personal fees from Samumed, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
