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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses a study that demonstrated long term deficits in muscle strength when anterior cruciate ligament (ACL) reconstruction was accompanied by femoral nerve blockade (FNB) in pediatric and adolescent patients.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESports Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Pediatrics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESports Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Pediatrics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ET. David Luo, MD, Mayo Clinic, Rochester, Minnesota, USA, reported on a study that demonstrated long term deficits in muscle strength when anterior cruciate ligament (ACL) reconstruction was accompanied by femoral nerve blockade (FNB) in pediatric and adolescent patients.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EFNB is often used to provide analgesia following ACL reconstructive surgery. Although rare, femoral neuropathy can occur, producing weakness, numbness, and pain. The effect that FNB complications might have on patients \u2264 18 years has been unclear.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe retrospective, matched cohort study compared outcomes at 6 months after ACL reconstructive surgery in 169 pediatric and adolescent patients whose surgery, conducted from 2001 to 2010, involved FNB or did not (control). The nerve blockade was accomplished using 20 to 50 ml of .25% or .5% marcaine under nerve stimulator or ultrasound guidance. Because of revision ACL surgery or prior ipsilateral or contralateral knee surgery, 45 patients were excluded. The remaining 124 patients comprised 62 patients in the FNB group (46 via continuous flow over 48 hours, 16 by single injection) and 62 patients in the control group.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe 6-month outcomes were isokinetic strength and function during slow extension and flexion (both 60\u00b0 per second), fast extension and flexion (both 180\u00b0 per second), vertical jump, triple jump, and single leg hop. The return to sports of the patients was also assessed. The cohorts were matched for baseline demographics (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14773\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14773\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14773\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EDemographics of the Matched Cohorts\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EConcerning surgical factors, the autograft type in patients who received a FNB was predominantly bone-patellar tendon-bone (69%), with hamstring autograft used in 31% of cases. The control group comprised similar percentages of each graft (66% bone-patellar tendon-bone autograft, 34% hamstring autograft). No differences were evident between the groups concerning concomitant procedures, including meniscus and cartilage repair, the type of anesthesia, or mechanism of injury. Significant differences were evident between the FNB and control groups in terms of tourniquet time (81.61 \u00b1 17.9 vs 92.9 \u00b1 17.2 min; p = .002), operative time (134.2 \u00b1 29.4 vs 155.3 \u00b1 45.1 min; p = .003), and anesthesia time (176.6 \u00b1 29.6 vs 199.5 \u00b1 43.0 min; p = .001).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EDiminished isokinetic strength at 6 months, measured as fast and slow extension and fast and slow flexion, was more prevalent in patients who received FNB; these differences were significant for fast extension and for fast and slow flexion. Functional testing at 6 months did not reveal significant differences between the patient groups.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAt 6 months, 90% of the patients in the control group and 68% of patients who received FNB following ACL reconstruction were cleared for a progressive return to pre-injury sports activities. The difference between the groups was significant (p = .002). Return to sports adjusted for surgical variables revealed significant associations with tourniquet time (OR, 5.6; p = .005), operative time (OR, 5.3; p = .003), and anesthesia time (OR, 6.7; p = .001).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe study findings indicate an association of FNB and significant isokinetic deficits in knee extension and flexion strength at 6 months postoperatively. In addition, the use of FNB delays patient return to sports activities at 6 months.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/23\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzoxa1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzoxa1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}