Effects of Continuous Passive Motion Following ACL Reconstruction with Autogenous Patellar Tendon Grafts

Abstract

This study examined the benefits and possible risks of immediate continuous passive motion after autogenous patellar tendon reconstruction of the anterior cruciate ligament. Thirty patients scheduled to undergo ACL reconstruction were prospectively randomized into two groups, CPM and non-CPM. Postoperatively, those in the non-CPM group wore a hinged knee brace. Those in the CPM group were kept on a CPM machine 16 hrs a day while in the hospital and they used it 6 hrs a day for the first 2 weeks postoperatively. After surgery the patients were assessed for hemovac drainage, range of motion, swelling, effusion, subjective pain, and use of pain medication. The CPM group had significantly less swelling and effusion, required less pain medication, and had greater knee flexion. No differences were found in hemovac drainage, passive knee extension, or subjective pain reports despite a significantly greater use of pain medication in the non-CPM group. The results suggest that immediate CPM after ACL reconstruction is safe and facilitates early range of motion by decreasing the amount of pain medication, effusion, and soft tissue swelling.

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

“…The eight articles included were published between 1987 and 2013 and were conducted in Australia (n = 1) [22], Italy (n = 1) [21], Sweden (n = 1) [13], Switzerland (n = 1) [18], Turkey (n = 1) [16], and the USA (n = 3) [19,20,23]. The total study population of all selected articles together comprised 442 participants, of whom 156 had been assessed for differences in range of motion in five studies [13,16,18,20,23], 122 for differences in swelling in four studies [13,20,21,23] and 336 for differences in pain in four studies [16,19,22,23]. All participants underwent arthroscopic ACL reconstruction using semitendinosus or patellar ligament tendon grafts, with or without meniscal repair.…”

“…All participants in the intervention groups received CPM after surgery. However, the onset of CPM varied from immediately after surgery [22,23] to starting on the third postoperative day [16]. The end of the CPM intervention also varied.…”

“…Range of motion in flexion was expressed in degrees measured by a customary goniometer as absolute values [16,18,20,23] or as flexion deficit compared to the non-operated knee [13]. Extension was expressed in degrees measured by goniometer as absolute values [16,20], as extension deficit [18] or as extension deficit compared to the non-operated knee [13].…”

“…Swelling was expressed in differences in cm circumference compared to the preoperative values [20,21] or in comparison to the sound leg [13], measured at upper-patella level or above as well as mid-patella [13,20,21]. In one study, swelling was expressed by a cross-sectional area measurement in cm 2 at lowerpatella level, above-patella and mid-patella [23].…”

A Systematic Review of Anterior Cruciate Ligament Reconstruction Rehabilitation –Part I: Continuous Passive Motion, Early Weight Bearing, Postoperative Bracing, and Home-Based Rehabilitation

“…In another 1992 study, Yates et al 26 evaluated the effects of 2 weeks of CPM following patellar tendon autograft ACL reconstruction. Using random sampling, 30 patients were randomized to either CPM 16 hours per day for the first 3 postoperative days followed by 6 hours per day for a total of 14 days use or an identical rehabilitation protocol without CPM.…”