title: The Effect of Femoral Nerve Block on Quadriceps Strength in Anterior Cruciate Ligament Reconstruction: A Systematic Review.
abstract: OBJECTIVE
  To assess the isokinetic, functional, and patient-reported outcomes of femoral nerve block (FNB) compared with traditional multimodal anesthesia for FNB in anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  A systematic search of PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Reviews, and Google Scholar was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Effects of FNB on quadriceps function were evaluated by isokinetic testing, functional scoring systems, range of motion, and patient self-report questionnaires. Heterogeneous reporting of outcomes precluded a formal meta-analysis. The methodologic merit of all studies included was evaluated by the Coleman Methodology Score.
  
  
  RESULTS
  Six studies were identified with outcome measures reported between 7 days and 6 months postoperatively. At 6 months, 2 of 4 studies that reported isokinetic testing found significantly greater deficits among patients who received a nerve block; one of the remaining studies showed a deficit at 6 weeks but not 6 months. Limited data showed no significant differences in functional or patient-reported outcomes at 6 months after reconstruction, and data regarding the impact of FNB on return to sport were inconclusive. The mean Coleman Methodology Score for the included studies was 53, indicating poor overall methodologic quality of the available literature.
  
  
  CONCLUSIONS
  The limited data available suggest that FNB causes a measurable deficit in quadriceps isokinetic strength during the early postoperative period but has no effect on functional outcomes or return to sport at 6 months after ACL reconstruction. However, current clinical evidence is not sufficient to draw any valid or definitive conclusions regarding the effect of FNB on postoperative outcomes after ACL reconstruction.
  
  
  METHODS
  Level IV, systemic review of Level I through IV studies.
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Swank
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Alex C
authors.initials: AC
authors.lastname: DiBartola
authors.affiliation: Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Everhart
authors.affiliation: Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.; OSU Sports Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kaeding
authors.affiliation: Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.; OSU Sports Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Magnussen
authors.affiliation: Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.; OSU Sports Medicine, The Ohio State University, Columbus, Ohio, U.S.A.; Cartilage Restoration Program, The Ohio State University, Columbus, Ohio, U.S.A.. Electronic address: david.flanigan@osumc.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000534:rehabilitation / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation; D005267:Femoral Nerve; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D053580:Muscle Strength / Q000502:physiology*; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D052097:Quadriceps Muscle / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology; D000068958:Return to Sport