Quadriceps tendon graft harvest was performed through a 3-cm longitudinal incision above the superior pole of the patella, through which a partial-thickness all soft-tissue quadriceps tendon graft 65 to 75 mm long was harvested. If a full-thickness graft harvest was required, the deep layer of the capsulotomy was closed using an absorbable suture. The graft donor site was closed in a standard fashion using a nonabsorbable high tensile strength suture to capture the rectus tendon and close the proximal half of the site. The distal half of the site was closed with a No. 1 Vicryl (Ethicon) suture. The graft was prepared with an adjustable loop button system on both sides.

After diagnostic arthroscopy, any meniscal tear was treated with partial meniscectomy or repair based on the surgeon’s assessment. All meniscal repairs in this series were accomplished using an all-inside technique using all-suture implants (FiberStitch; Arthrex). Any chondromalacia was addressed with chondroplasty.

The ACL remnants were then debrided, and independent tibial and femoral sockets were prepared using a retrograde drilling method. The ACLR was completed using an all-inside technique, whereby the graft is passed into the joint through a cannula placed into the medial portal before being seated into the respective sockets. The suspensory fixation systems on both sides of the graft were then tightened manually with the knee in full extension and a posterior drawer force applied to the proximal tibia. Surgical incisions were closed in a standard fashion using absorbable sutures.

Postoperatively, each patient was placed in a hinged knee brace and instructed to remain touch-down weightbearing for 2 weeks. Patients were instructed to take acetaminophen and ibuprofen around the clock for 48 hours and then as needed. No formal standards for opioid prescribing were provided to practitioners, and patients were prescribed 8 to 25 tablets of 5-mg oxycodone tablets or a comparable amount of liquid oxycodone (with a weight-based dose of 0.1 mg/kg/dose) to be taken every 4 to 6 hours for pain as needed. All patients were discharged home on the day of surgery.

Pain surveys were electronically sent to each patient after discharge in an automated fashion. Patients were asked to report rest pain and pain with activity using the NRS pain score over 3 periods approximating the 24-hour period after surgery (4 PM to 12 AM the night of surgery, 12 AM to 8 AM, and 8 AM to 4 PM), as well as once on POD3 and once on POD7. Surveys were delivered by Research Electronic Data Capture (REDCap) links sent to patients via e-mail or text message (see Appendix 1 , available at www.arthroscopyjournal.org ), depending on patient and family preference. Patients self-reported the opioid use over the periods outlined. Mean, median, standard deviation, and range were calculated for pain scores at the different time points. Opioid consumption was similarly analyzed. Pairwise comparisons between the subgroups with and without femoral nerve catheters were done using Wilcoxon rank-sum tests and Fisher exact tests. Univariate tests were performed to check for any association between recorded variables and the outcomes of POD3 opioid use or POD3 pain level ≥5. This threshold was chosen to represent moderate to severe pain. Statistical analysis was done in Excel (Microsoft) and Stata 14.1 (StataCorp). An α level of <.05 was used as the threshold for statistical significance.