{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:58:00Z","timestamp":1781917080675,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,10,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Regional anesthesia is commonly used for adolescent anterior cruciate ligament reconstruction, but its effect on functional recovery is uncertain. We examined whether the use or type of nerve block influenced recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>15 institutions contributed to a prospective observational registry of patients aged 12\u201317 years undergoing anterior cruciate ligament reconstruction. Functional recovery was assessed using the Lysholm Knee Score (range 0\u2013100; higher scores indicate better function) at postoperative day 1, day 3, week 6 and month 6, and the Limb Symmetry Index (percentage of operative to non-operative limb performance; values \u226590% indicate readiness to return to sport) at 6\u20139 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 519 patients were enrolled. Lysholm Scores improved over time in all groups. At week 6, patients who received both anterior and posterior blocks had a median Lysholm Score of 83 (good function) compared with 78 for those with no block or anterior block alone (p=0.041). By month 6, scores were similar across groups, with most patients reaching the good to excellent range. Younger patients (12\u201315 years) reported higher scores than older adolescents (median 89 vs 86, p&lt;0.05), while females reported lower scores than males at several time points. High early postoperative pain (numerical rating scale \u22657) predicted lower function through week 6. Positive temperament and lower preoperative anxiety\/depression scores predicted better outcomes. At 6\u20139 months, 67% achieved a Limb Symmetry Index \u226590%. Younger age increased the odds of a suboptimal Limb Symmetry Index (&lt;90%) (OR 2.54, p=0.03). Nerve block type was not associated with Limb Symmetry Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Regional anesthesia did not impair functional outcomes after adolescent anterior cruciate ligament reconstruction. Most patients regained good knee function by 6 months, and two-thirds achieved readiness for return to sport by 9 months. Recovery was more strongly influenced by age, sex, and psychological profile than by nerve block use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04329117\">NCT04329117<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107017","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:45:24Z","timestamp":1761810324000},"page":"rapm-2025-107017","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Regional anesthesia and functional outcomes after anterior cruciate ligament reconstruction surgery in adolescent patients: Society of Pediatric Anesthesia Improvement Network (SPAIN)"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct04329117","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Tessa","family":"Mandler","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Children\u2019s Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galaxy","family":"Li","sequence":"additional","affiliation":[{"name":"Nemours Children\u2019s Health System, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesavan","family":"Sadacharam","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Pain Medicine, Nemours Children\u2019s Hospital Delaware, Wilmington, Delaware, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J","family":"Staffa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7913-1932","authenticated-orcid":false,"given":"Vidya","family":"Chidambaran","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galit","family":"Kastner Ungar","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wallis T","family":"Muhly","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cravero","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5698-7797","authenticated-orcid":false,"given":"Allison M","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Anesthesia and Pain Management, Johns Hopkins All Children\u2019s Hospital, St Petersburg, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"2025103000451724000_rapm-2025-107017v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000001222"},{"key":"2025103000451724000_rapm-2025-107017v1.2","doi-asserted-by":"crossref","unstructured":"Sadacharam K , Mandler T , Staffa SJ , et al . 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Preoperative Psychological Factors, Postoperative Pain Scores, and Development of Posttraumatic Stress Disorder Symptoms After Pediatric Anterior Cruciate Ligament Reconstruction. 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