Continuous passive motion in rehabilitation after anterior cruciate ligament reconstruction

Engström, Birgitta; Sperber, Anders; Wredmark, Torsten

doi:10.1007/bf01553520

Cited by 27 publications

(37 citation statements)

References 12 publications

(14 reference statements)

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“…58 Multiple studies have shown that the use of a CPM does not affect range of motion or anterior laxity after ACL reconstruction. 57,[59][60][61] Given the cost associated with CPM and the lack of effect on overall functional outcomes, it is hard to justify their use as purely an adjunct to pain control without definitive level 1 supportive evidence. 62…”

Section: Continuous Passive Motion Devicesmentioning

confidence: 99%

Evidence-Based Approach of Treatment Options for Postoperative Knee Pain

Farr¹,

Jaggers

Lewis

et al. 2014

The Physician and Sportsmedicine

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Optimal pain management is critical after knee surgery to avoid adverse events and to improve surgical outcomes. Pain may affect surgical outcomes by contributing to limitations in range of motion, strength, and functional recovery. The causes of postoperative pain are multifactorial; therefore, an appropriate pain management strategy must take into account preoperative, intraoperative, and postoperative factors to create a comprehensive and individualized plan for the patient. Preoperative assessment includes management of patient expectations, recognition of conditions and early counseling for high-risk patients (ie, opioid dependence, psychiatric comorbidities), and use of preemptive analgesia techniques (ie, preoperative IV medications, peripheral nerve blocks, incisional field blocks). Intraoperative strategies include meticulous surgical technique, limiting the use of tourniquets (ie, duration and pressure), and using preventive analgesia methods (ie, postoperative field block, continuous nerve catheters, intra-articular injection). Postoperative analgesia may be facilitated by cryotherapy, early mobilization, bracing, and rehabilitation. Certain modalities (ie, continuous passive motion devices, transcutaneous electrical nerve stimulation units, iontophoresis) may be important adjuncts in the perioperative period as well. There may be an evolving role for alternative medicine strategies. Early recognition and treatment of exaggerated postoperative pain responses may mitigate the effects of complex regional pain syndrome or the development of chronic pain.

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Section: Continuous Passive Motion Devicesmentioning

confidence: 99%

Evidence-Based Approach of Treatment Options for Postoperative Knee Pain

Farr¹,

Jaggers

Lewis

et al. 2014

The Physician and Sportsmedicine

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show abstract

“…Methods of the analysis and inclusion criteria were specified in advance, documented in a protocol and published on the Prospero international prospective register of systematic reviews, registration number CRD42014015077. The systematic literature search, the analysis and synthesis were performed according to the PRISMA statement [13].…”

Section: Protocol and Registrationmentioning

confidence: 99%

Continuous Passive Motion Does Improve Range of Motion, Pain and Swelling After ACL Reconstruction: A Systematic Review and Meta-Analysis

et al. 2018

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Background This systematic review and meta-analysis evaluates the results of empirical studies on the effects of CPM on rehabilitation after ACL reconstruction. The research question was: what are the effects of CPM on ROM, swelling and pain after ACL reconstruction? Patients/Material and Methods We searched in MEDLINE, Embase, CINAHL, Cochrane and PEDro up to January 2018. Standardized mean differences (SMD) were expressed as Hedgesʼ g, in order to correct for overestimation of the true effect in small study samples. The 95% confidence intervals (95% CI) were calculated for both the individual studies and the overall weighted estimate. Outcomes were range of motion, pain and swelling. Results Eight studies comprising 442 participants were included in the meta-analysis. Beneficial effects of CPM could be identified for the need for pain medication (Hedgesʼ g = 0.93; 95% CI = 0.41 to 1.45 during the first 24 hours after surgery), the number of PCA button pushes by the patient during the first 24 hours after surgery (MD = 31.20; 95% CI = 11.35 to 51.05), on regaining knee flexion on the third to the seventh postoperative day (MD = 11.6°; 95% CI = 1.96 to 21.33) as well as in the third to the sixth postoperative week (Hedgesʼ g = 0.93; 95% CI = 0.41 to 1.44) and on swelling of the knee in the fourth to sixth postoperative week (Hedgesʼ g = 0.77; 95% CI = 0.35 to 1.18). Conclusion This meta-analysis suggests that CPM has beneficial effects on pain reduction during the first two postoperative days, on knee flexion during the first to the sixth postoperative weeks and on swelling between the fourth and the sixth postoperative weeks. However, the risk-of-bias scores do not allow a high level of evidence.

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“…Obwohl die Orthesenverwendung in unserer Umfrage bei 82,8 % der Befragten üblich ist und in den aktuellen DGOU-Nachbehandlungsempfehlungen bis 6 Wochen postoperativ empfohlen wird, gibt es kaum Evidenz, die einen Ortheseneinsatz unterstützt. In einer Arbeit von Giotis [11]. Der nicht nachgewiesene Benefit durch die CPM-Schiene wurde auch in einer Literaturzusammenfassung im Rahmen der MOON-Leitlinien unterstrichen [41].…”

Section: Ergebnisseunclassified