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Postoperative pain after anterior cruciate ligament reconstruction using a transligamentous approach

Hagavik Orthopaedic Hospital, University of Bergen, Bergen, Norway

Torbjørn Strand, MD

Hagavik Orthopaedic Hospital, University of Bergen, Bergen, Norway

Anterior cruciate ligament reconstruction by free patel lar tendon graft was performed using 2 different surgical approaches to the intercondylar notch in 67 consecu tive patients with chronic anterior cruciate ligament insufficiency. In the first 30 patients (Group A), the traditional medial parapatellar arthrotomy with lateral luxation of the patella was done, whereas in the last 37 patients (Group B) a transpatellar tendon approach was used. Postoperative pain was managed by analgesics and, in patients who had epidural anesthesia, by ad ministration of bupivacaine in indwelling catheters. Gen erally, the analgesics and bupivacaine were given im mediately on request to establish comfort at rest and to permit range of motion exercises without severe pain. Compared with those in Group A, the patients of Group B had a significantly longer period from the first dose of analgesic or bupivacaine to the second, and the total number of doses of analgesic or bupivacaine was significantly lower. In the subgroup of patients with epidural anesthesia (21 in Group A and 32 in Group B), the Group B patients required significantly less anal gesics, as doses equivalent to 10 mg of morphine, compared with that of Group A.