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.