The efficacy of post-operative devices following knee arthroscopic surgery: a systematic review.
OBJECTIVE
There is a wide array of device modalities available for post-operative treatment following arthroscopic knee surgery; however, it remains unclear which types and duration of modality are the most effective. This systematic review aimed to investigate the efficacy of device modalities used following arthroscopic knee surgery.


METHODS
A systematic search of the literature was performed on: PubMed; Scopus; MEDLINE; EMBASE; PEDro; SportDiscus; and CINAHL databases (1995-2015) for clinical trials using device modalities following arthroscopic knee surgery: cryotherapy, continuous passive motion (CPM), neuromuscular electrical stimulation (NMES), surface electromyographic (sEMG) biofeedback and shockwave therapy (ESWT). Only level 1 and 2 studies were included and the methodological quality of studies was evaluated using Physiotherapy Evidence Database (PEDro) scores. Outcome measures included: muscle strength, range of motion, swelling, blood loss, pain relief, narcotic use, knee function evaluation and scores, patient satisfaction and length of hospital stay.


RESULTS
Twenty-five studies were included in this systematic review, nineteen of which found a significant difference in outcomes. For alleviating pain and decreasing narcotic consumption following arthroscopic knee surgery, cryocompression devices are more effective than traditional icing alone, though not more than compression alone. CPM does not affect post-operative outcomes. sEMG biofeedback and NMES improve quadriceps strength and overall knee functional outcomes following knee surgery. There is limited evidence regarding the effects of ESWT.


CONCLUSIONS
Cryotherapy, NMES and sEMG are recommended for inclusion into rehabilitation protocols following arthroscopic knee surgery to assist with pain relief, recovery of muscle strength and knee function, which are all essential to accelerate recovery. CPM is not warranted in post-operative protocols following arthroscopic knee surgery because of its limited effectiveness in returning knee range of motion, and additional studies are required to investigate the effects of ESWT.


METHODS
II.
Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.|Human Performance Laboratory, Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA, 94305, USA.
Corey T
CT
Gatewood
Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.|Stanford University School of Medicine, Stanford University, Stanford, CA, USA.|Human Performance Laboratory, Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA, 94305, USA.
Andrew A
AA
Tran
Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA. jdragoo@stanford.edu.|Stanford University School of Medicine, Stanford University, Stanford, CA, USA. jdragoo@stanford.edu.|Human Performance Laboratory, Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA, 94305, USA. jdragoo@stanford.edu.
Jason L
JL
Dragoo
D001182:Arthroscopy / Q000534:rehabilitation*; D017679:Cryotherapy; D004599:Electric Stimulation Therapy; D019220:High-Energy Shock Waves; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D015915:Motion Therapy, Continuous Passive; D053580:Muscle Strength; D058765:Neurofeedback; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care; D020127:Recovery of Function
ACL; Anterior cruciate ligament reconstruction; Continuous passive motion; Cryotherapy; Neuromuscular electrical stimulation; Shockwave therapy; Surface electromyographic biofeedback
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