Inclusion Criteria:

1. Age 18-45 years
2. Scheduled for primary ACLR with BPTB autograft
3. Willingness and ability to participate in Iovera
4. No chronic opioid use preoperatively
5. No known neurologic disorders affecting the lower extremity
6. Capacity and willingness to provide informed consent and comply with follow-up schedules

Exclusion Criteria:

1. Prior surgery on the affected knee.
2. Non-English speaking if validated PRO instruments at the site are only available in English; include validated translations if available and approved.
3. Contraindications to cryoneurolysis (e.g., cryoglobulinemia, cold urticaria, Raynaud's phenomenon, paroxysmal cold hemoglobinuria) or to local anesthetics.
4. Active skin infection, dermatitis, or compromised skin integrity at or near treatment sites.
5. Bleeding diathesis or anticoagulant therapy not compatible with minor percutaneous procedures per institutional policy.
6. Pregnancy or breastfeeding.
7. Known peripheral neuropathy or significant sensory deficit of the target region.
8. Any condition that, in the investigator's judgment, increases risk or interferes with participation
9. Concomitant use of other opioid drugs or prior chronic use.