Cryotherapy Decreases Intraarticular Temperature after ACL Reconstruction

Abstract

Cryotherapy has been shown to decrease intraarticular temperature in all regions of the knee after arthroscopy. The purpose of our study was to determine if similar declines in intraarticular temperature were seen with the use of cryotherapy after anterior cruciate ligament reconstruction, a procedure which, unlike simple arthroscopy, produces postoperative hemarthrosis. Sixteen patients had intraarticular temperatures measured for 2 hours after anterior cruciate ligament reconstruction with cryotherapy instituted for only 1 of the 2 hours (eight patients for the first hour and eight patients for the second hour). Significant declines were seen in the suprapatellar pouch after either hour (−2.7°C in Group 1, −2.7°C in Group 2) but not in the lateral gutter. The difference between cryotherapy versus no cryotherapy in the first hour in the suprapatellar pouch was 6.0°C, a clinically meaningful temperature difference. We hypothesize the swelling and hemarthrosis was more pronounced in the lateral gutter because of its dependent position and therefore blunted the effect of cryotherapy seen in the lateral gutter. Cooling of the intraarticular temperature should be considered in the clinical benefits of cryotherapy.Cryotherapy has been used since ancient times for its beneficial effect on injuries. 9,14 The effects of cryotherapy on lowering tissue metabolism, hypoxia, edema, inflammatory mediator release, nerve conduction, and pain have been well documented. [1][2][3][4][7][8][9][10][13][14][15][16][19][20][21] Cryotherapy frequently is used in postoperative treatment after many arthroscopic procedures to decrease swelling and pain. 10,11,21 Martin et al 11 described a statistically and clinically significant temperature difference of 7.1°C in the lateral gutter after arthroscopy in knees treated with cryotherapy versus knees not receiving cryotherapy. They also saw that cryotherapy decreases the intraarticular temperature of the knee after simple arthroscopic procedures in the medial gutter and suprapatellar pouch. Therefore the clinical benefits observed with cryotherapy after simple arthroscopic procedures may be related to the cooling effect on the intraarticular environment and synovium. After arthroscopic ACL reconstructions postoperative pain, intraarticular bleeding, and extraarticular swelling are increased compared with after simple arthroscopy. Therefore, if similar intraarticular temperature changes are observed with the use of cryotherapy after ACL reconstruction as in simple arthroscopy, the response of the synovium to cooling could be correlated with postoperative pain and recovery time. The purpose of our study was to determine if the use of cryotherapy after ACL reconstruction produced a decrease in intraarticular temperature similar to what has been observed after simple arthroscopic procedures. MATERIALS AND METHODSAfter institutional review board approval and informed consent were obtained 16 ACL reconstructions were done on 16 knees (nine right knees and seven left knees) in 16 patients. The study...

Temperature-controlled continuous cold flow device versus traditional icing regimen following anterior cruciate ligament reconstruction: a prospective randomized comparative trial

“…Cryotherapy is frequently used in orthopedics for postoperative analgesia [5][6][7][8][9][10][11][12][13][14]. Despite the above-mentioned advantages of cryotherapy, it is not clear which should be the best method to administer cryotherapy to the patients, traditional coolant, or continuous cold flow device.…”

“…Many authors highlighted the importance of an aggressive rehabilitation protocol focused on the improvement of the mid-and long-term clinical outcome following ACL surgery [5]. For this reason, it appears important to adopt measures aimed to reduce pain and edema in the immediate post-operative period to allow early mobilization.…”

Rehabilitation After Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction

“…8,28,35,46,62,91 Studies have shown significant drops in both skin and intraarticular temperatures in the knee with the use of cold therapy after ACLR. 35,91 Certain prospective, randomized, placebo-controlled clinical trials have demonstrated a reduction in postoperative narcotic consumption and visual analog pain scores for patients treated with continuous postoperative cold therapy, whereas others have failed to show any significant effect.…”

“…8,28,35,46,62,91 Studies have shown significant drops in both skin and intraarticular temperatures in the knee with the use of cold therapy after ACLR. 35,91 Certain prospective, randomized, placebo-controlled clinical trials have demonstrated a reduction in postoperative narcotic consumption and visual analog pain scores for patients treated with continuous postoperative cold therapy, whereas others have failed to show any significant effect. 8,28,46,62 The basic science underlying the effectiveness of cryotherapy reveals multimodal effects, including slowing of afferent nerve conduction velocity, promotion of local vasoconstriction that decreases bleeding and edema, and a slowing of local cellular metabolism that diminishes cellular hypoxia and reduces release of inflammatory mediators.…”

Local cryotherapy is ineffective in accelerating recovery from exercise-induced muscle damage on biceps brachii

“…Previous studies have shown that cryotherapy provides an analgesic effect and helps to decrease muscle spasms [3,4]. Furthermore, cold therapy promotes structural and functional restoration by reducing blood flow, tissue temperature, and metabolism, limiting edema formation [5,6]. More recently, cryotherapy has been extensively utilized to attenuate symptoms of exercise-induced muscle damage (EIMD) such as delayed onset muscle soreness (DOMS) and decreased strength [7][8][9].…”