Preoperative Cryotherapy Use in Anterior Cruciate Ligament Reconstruction

Abstract

Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p < 0.02) and used less narcotic use (average 1.7 tablets, p < 0.02) for the first 36 hours compared with group 1. No statistically significant differences were identified between the two groups with regard to demographics, hours of postoperative cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction.

Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation

“…This evidence is consistent with previous literature that has deemed bracing to have no beneficial effects 62 . Both preoperative 18 and postoperative 19 uses of cryotherapy were effective at reducing pain perception, and preoperative use also reduced painkiller consumption 18 . Various types of intraoperative analgesia were investigated for their effects on postoperative pain scores and muscular function; periarticular injections were found to yield significantly better pain scores 32 , and both femoral nerve blocks and adductor canal blocks did not lead to any significant differences in long-term quadriceps muscular function 30,31 .…”

“…Cryotherapy includes the use of cold packs, ice massage, cold baths, vapocoolant sprays, and cold compression units and is an analgesic technique used to relieve muscular soreness following musculoskeletal injury 17 . Two studies were included that investigated the use of cold therapy as an analgesic for populations undergoing ACL reconstruction 18,19 (Table V). The results provided further evidence to support the use of cryotherapy both preoperatively 18 and postoperatively 19 as an analgesic for patients in ACL reconstruction (Table I).…”

Evaluation of the Clinical Efficacy of Using Thermal Camera for Cryotherapy in Patients with Total Knee Arthroplasty: A Prospective Study

“…Some data suggest that cryotherapy and cold application reduces edema around the knee by reducing vasodilation after TKA [18,19]. Moreover, Ruffilli et al evaluated knee circumference and found no significant postoperative difference in the measurements of 15 upper and lower patella regions [16].…”

Day surgery for anterior cruciate ligament reconstruction in children: A prospective study on feasibility and satisfaction

“…They found no negative effect of cold therapy on knee stability after studying tibial translation. In 2014, Koyonos et al 19 questioned the indication for intraoperative cryotherapy and found a significative reduction in pain and analgesic intake. Several studies also showed the advantage of compressive therapy combined with cryotherapy.…”