One hundred twenty-seven patients undergoing unilateral Anterior cruciate ligament reconstruction (ACLR) were randomized to receive a proximal adductor canal block with 0.5% ropivacaine 15 mL (Group C; n=43), the same block plus a pes anserinus tendon block with 0.5% ropivacaine 15 mL per site (Group N1; n=41), or the same dual block with 5 mg dexamethasone added (Group N2; n=43). The primary outcome was pain (VAS) at rest and with knee flexion across predefined time points to 72 hours. Secondary outcomes included time to first ambulation, intra- and postoperative analgesic use, Ramsay sedation, quadriceps strength, anxiety (HADS-A), sleep scores, breakthrough pain, and adverse events, assessed through 72 hours. Overall, the results showed significantly lower VAS scores at all time points and faster first ambulation with the combined blocks versus adductor canal block alone; analgesic rescue and breakthrough pain were also reduced, with no decrement in quadriceps strength. The findings suggest that adding a pes anserinus tendon block meaningfully improves early recovery after ACLR without compromising motor function; adjunct dexamethasone conferred no clear 3-day advantage.