Summary

Intraoperative, intraarticular, drug cocktail injection following ACL Reconstruction surgery is a useful tool to reduce pain in the immediate post operative period and it also results in better functional recovery.

Abstract

Introduction

ACL Reconstruction surgery is frequently associated with significant amount of pain in the immediate post operative period. Early postoperative rehabilitation is negatively affected by postoperative pain leading to a less than satisfactory outcome. The use of post operative drug cocktail injection is a well-established and widely followed practice after total knee replacement, however its use after an ACL reconstruction surgery in not common. In this study we aim to establish the efficacy of intraoperative, intraarticular, drug cocktail injection [IIDCI] following single bundle anterior cruciate ligament reconstruction using ipsilateral hamstring tendons. We have conducted a randomized control trial comparing the efficacy of IIDCI in ACLR and compared that with equal number of patients who did not get the IIDCI after an ACLR.

Methods

30 patients undergoing ACL reconstruction were given IIDCI and were compared with equal number of controls who underwent ACL reconstruction and were not given the IIDCI. Postoperative pain was assessed using the visual analogue scale (VAS) and recorded at 6, 12, 18 and 24 hour after the spinal block; time to first analgesic request; postoperative consumption of intravenous tramadol and postoperative complications such as nausea, vomiting, sedation, local wound complications and pruritus were recorded. Post operative functional recovery was also compared using IKDC and Tegner Lysolm Scores at 4, 8, 12, 24 and 48 weeks after surgery.

Results

VAS scores were significantly better in the IIDCI group at 6 hours, 12 hours and 18 hours after surgery [p value <0.05]. The scores became comparable by 24 hours after the surgery. Post operative functional recovery was better in the IIDCI group at 4 weeks and 8 weeks after surgery [p value <0.05] and becomes comparable from 12 weeks onwards.

Discussion

Less pain in the immediate perioperative period results in improved functional outcomes in the post operative period. Our study data mirrors what is seen in joint replacement studies where IIDCI groups do better in perioperative pain scores and post operative functional recovery.

Conclusion

IIDCI following ACL Reconstruction surgery is a useful tool to reduce pain in the immediate post operative period. It also results in better functional recovery.
Keywords: Drug, ACL Reconstruction, Arthroscopy, Cocktail