Objective To explore the feasibility of ultrasound‑guided adductor canal block (ACB) combined with popliteal plexus block (PPB) in analgesia after anterior cruciate ligament reconstruction (ACLR) under knee arthroscopy. Methods A total of 58 patients, aged 18‒60 years, scheduled for unilateral ACLR under general anesthesia at the First Affiliated Hospital of Hainan Medical University from March 2023 to March 2024, were selected, According to the random number table method, they were divided into two groups: an adductor canal block group (group A, n=28) and an adductor canal block combined with popliteal plexus block group (group AP, n=30). In group A, patients received ACB under ultrasound guidance with 0.25% ropivacaine+1 µg/kg dexmedetomidine (15 ml in total). In group AP, patients received underwent PPB with 0.25% ropivacaine+1 µg/kg dexmedetomidine (10 ml in total for PPB), in addition to the same treatment in group A. All the patients were subsequently subject to general anesthesia via laryngeal mask airway. The Visual Analog Scale (VAS) at rest and during movement, limb motor function, quadriceps muscle strength grading at the time of postoperative recovery (T0), 6 h (T1), 12 h (T2), 18 h (T3), 24 h (T4), 36 h (T5), 48 h (T6), and 72 h (T7), and the number of weakened cases of limb motor function and quadriceps muscle strength grading were recorded; additional parameters recorded, time to first rescue analgesia, use of diclofenac sodium postoperatively, rate of rescue analgesia, and time to sensory recovery of the medial calf; mean arterial pressure (MAP) and heart rate were recorded at 10 min after block, at surgery start, surgery end, and at postoperative 6 h and 12 h; the incidences of hypotension, bradycardia, and postoperative complications (nausea, vomiting, and falls) as well as nerve block‑related complications (nerve injury, hematoma, and infection) were also noted. Results Compared with group A, group AP showed significant decreases in VAS scores at rest and during at T0, T1, T2, and T5 (all P<0.05), while differences at T3, T4, T6, T7 were not statistically significant (all P>0.05). Group AP had a longer time to first rescue analgesia, less diclofenac sodium use postoperatively, and a lower rate of rescue analgesia (all P<0.05). There were no statistical differences between the two groups in quadriceps strength grading, limb motor function scores, cases of weakened quadriceps strength, or time to sensory recovery of the medial calf (all P>0.05). At post‑block 10 min, MAP and heart rate in group AP were lower than those in group A (all P<0.05), but no significant differences were observed before the block, at the start or end of surgery, or at postoperative 6 h and 12 h (all P>0.05). There was no significant difference in the incidence of adverse reactions between the two groups (all P>0.05). Conclusions Ultrasound‑guided ACB combined with PPB can effectively alleviate postoperative pain following ACLR, with little impact on quadriceps and ankle joint function, facilitating early functional exercise and rehabilitation while reducing the need for postoperative analgesics.