title: The efficacy of combined cryotherapy and compression compared with cryotherapy alone following anterior cruciate ligament reconstruction.
abstract: While cryotherapy has been shown to decrease postoperative pain after anterior cruciate ligament (ACL) reconstruction, less is known of the effects of combined cryotherapy and compression. The goal of this study was to compare subjective and objective patient outcomes following ACL reconstruction with combined compression and cryotherapy compared with traditional ice therapy alone. Patients undergoing ACL reconstruction were randomized to cryotherapy/compression device (group 1) or a standardized ice pack (group 2). Both groups were instructed to use the ice or cryotherapy/compression device three times per day and return to the clinic at 1, 2, and 6 weeks postoperatively. Patient-derived outcome measurements used in this study consisted of the visual analog scale (VAS), the Lysholm knee score, Short Form-36 (SF-36), and single assessment numerical evaluation (SANE). Circumferential measurements of the knee at three locations (1 cm proximal to patella, mid-patella, and 1 cm distal to patella) were also obtained as a measure of postoperative edema. Narcotic medication use was recorded by questionnaire. The primary outcome measure (VAS) was significantly different among groups in the preoperative measurement, despite similarities in group demographics. Baseline VAS for group 1 was 54.9 compared with group 2 at 35.6 (p = 0.01). By 6 weeks, this had lowered to 28.1 and 40.3, respectively, resulting in a significant 27-point decrease in mean VAS for group 1 (p < 0.0001). However, the small increase in VAS for group 2 was not significant (p = 0.34). No significant differences were noted for the Lysholm, SF-36, or SANE scores either between groups or time points. Furthermore, no significant differences were noted for any of the circumferential measurements either between groups or time points. Of all patients, 83% of group 1 discontinued narcotic use by 6 weeks, compared with only 28% of group 2 (p = 0.0008). The use of combined cryotherapy and compression in the postoperative period after ACL reconstruction results in improved, short-term pain relief and a greater likelihood of independence from narcotic use compared with cryotherapy alone.
authors.affiliation: Department of Orthopaedics, William Beaumont Army Medical Center, El Paso, Texas, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Waterman
authors.forename: John J
authors.initials: JJ
authors.lastname: Walker
authors.forename: Chad
authors.initials: C
authors.lastname: Swaims
authors.forename: Michael
authors.initials: M
authors.lastname: Shortt
authors.forename: Michael S
authors.initials: MS
authors.lastname: Todd
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Machen
authors.forename: Brett D
authors.initials: BD
authors.lastname: Owens
mesh_terms: D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D017679:Cryotherapy; D005260:Female; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome