Use of cryotherapy within the postoperative administration of paediatric anterior cruciate ligament reconstruction: a potential randomised managed trial

Wong JYS, Ashik MBZ, Mishra N, Lee NKL, Mahadev A, Lam KY. J Pediatr Orthop B. 2023 Aug 25. doi: 10.1097/BPB.0000000000001120. Epub forward of print. PMID: 37669155.
https://pubmed.ncbi.nlm.nih.gov/37669155/

Take-House Message

Younger sufferers skilled minimal advantages in ache and vary of movement from utilizing an ice pack throughout the first 6 weeks after an anterior cruciate ligament (ACL) reconstruction (ACLR).

Background

ACL accidents and subsequent ACLRs have gotten extra widespread within the younger lively inhabitants. Nevertheless, we lack a consensus on the most effective remedy protocols following ACLRs inside this inhabitants. For instance, some clinicians disagree about whether or not to make use of cryotherapy acutely after ACLR.

Research Objective

The authors sought to look at the efficacy of cryotherapy in relieving postoperative ache and restoring knee vary of movement after ACLR in pediatric sufferers over 6 weeks.

Strategies

The authors randomized 42 pediatric sufferers (~15 years of age; 55% feminine) present process ACLR from January 2019 to December 2020 right into a post-surgical ice group (n=21) or no ice group (n=21) and assessed ache at relaxation and on motion through a visible analog scale and knee vary of movement at baseline (day 1 after surgical procedure) after which 1,4, and 6 weeks post-surgery. Sufferers inside the ice group obtained an ice pack and utilized the pack 3 occasions a day for 20 minutes with a 4-hour minimal window between ice remedies for six weeks. Sufferers have been excluded from knowledge evaluation in the event that they missed greater than 2 of the 6 physiotherapy visits.

Outcomes

The ice remedies had minimal impression on knee extension vary of movement and ache at relaxation or with motion. Instantly after surgical procedure, the no-ice group had higher knee flexion vary of movement than these receiving ice (53 vs. 31 levels). The ice group then had extra enhancements in vary of movement throughout the first 6 weeks after surgical procedure in comparison with the no-ice group (99 vs. 65 levels enchancment; ultimate vary of movement: 130 vs. 119 levels). Nobody reported a chilly damage or pores and skin change.

Viewpoints 

The authors recommend that including cryotherapy throughout the acute stage after ACLR is a low-risk intervention that might enhance vary of movement outcomes. Nevertheless, we have to be cautious since every group solely had 21 members, and the teams began with totally different quantities of knee flexion vary of movement. It will be useful to carry out bigger research that discover these outcomes, remedy use, compliance/adherence, and affected person preferences/expectations. It will be attention-grabbing to know if different methods, equivalent to chilly water immersion or lively restoration, would enhance outcomes higher than an ice pack. Moreover, it could be attention-grabbing to make use of newer evaluation methods to find out if an ice pack provided ache reduction instantly after the remedy in comparison with earlier than. The ice packs might provide minimal profit at biweekly visits however present substantial reduction within the second. We’d like extra proof to tell the easiest way to deal with younger sufferers after an ACLR, however an ice pack is a low-cost, low-risk remedy that can be utilized if a affected person needs.  

Scientific Implications

Medical professionals can proceed to offer athletes with cryotherapy schooling and remedy choices. Nevertheless, they need to be aware that the enhancements in ache and ROM are small. This data is vital to speak with sufferers to allow them to make knowledgeable remedy choices about whether or not they wish to proceed with ice.

Questions for Dialogue

Do you encourage your sufferers to make use of ice after surgical procedure? What outcomes have you ever seen utilizing ice? Do you employ different various strategies to lower ache and improve vary of movement inside 6 weeks post-surgery?

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Written by Jane McDevitt
Reviewed by Jeffrey Driban