title: Cryotherapy with dynamic intermittent compression for analgesia after anterior cruciate ligament reconstruction. Preliminary study.
abstract: BACKGROUND
  Cryotherapy is a useful adjunctive analgesic measure in patients with postoperative pain following anterior cruciate ligament (ACL) surgery. Either static permanent compression or dynamic intermittent compression can be added to increase the analgesic effect of cryotherapy. Our objective was to compare the efficacy of these two compression modalities combined with cryotherapy in relieving postoperative pain and restoring range of knee motion after ligament reconstruction surgery.
  
  
  OBJECTIVE
  When combined with cryotherapy, a dynamic and intermittent compression is associated with decreased analgesic drug requirements, less postoperative pain, and better range of knee motion compared to static compression.
  
  
  METHODS
  We conducted a case-control study of consecutive patients who underwent anterior cruciate ligament reconstruction at a single institution over a 3-month period. Both groups received the same analgesic drug protocol. One group was managed with cryotherapy and dynamic intermittent compression (Game Ready(®)) and the other with cryotherapy and static compression (IceBand(®)).
  
  
  RESULTS
  Of 39 patients, 20 received dynamic and 19 static compression. In the post-anaesthesia recovery unit, the mean visual analogue scale (VAS) pain score was 2.4 (range, 0-6) with dynamic compression and 2.7 (0-7) with static compression (P=0.3); corresponding values were 1.85 (0-9) vs. 3 (0-8) (P=0.16) after 6 hours and 0.6 (0-3) vs. 1.14 (0-3) (P=0.12) at discharge. The cumulative mean tramadol dose per patient was 57.5mg (0-200mg) with dynamic compression and 128.6 mg (0-250 mg) with static compression (P=0.023); corresponding values for morphine were 0mg vs. 1.14 mg (0-8 mg) (P<0.05). Mean range of knee flexion at discharge was 90.5° (80°-100°) with dynamic compression and 84.5° (75°-90°) with static compression (P=0.0015).
  
  
  CONCLUSIONS
  Dynamic intermittent compression combined with cryotherapy decreases analgesic drug requirements after ACL reconstruction and improves the postoperative recovery of range of knee motion.
  
  
  METHODS
  Level III, case-control study.
authors.affiliation: Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France. Electronic address: murgier.jerome@hotmail.fr.
authors.forename: J
authors.initials: J
authors.lastname: Murgier
authors.affiliation: Clinique des Cèdres, château d'Alliez, 31700 Cornebarrieu, France.
authors.forename: X
authors.initials: X
authors.lastname: Cassard
mesh_terms: D000293:Adolescent; D000328:Adult; D000698:Analgesia / Q000379:methods*; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACL reconstruction; Analgesia; Cryotherapy