Knee Immobilization for Pain Control after a Hamstring Tendon Anterior Cruciate Ligament Reconstruction

Hiemstra, Laurie A.; Heard, S. Mark; Sasyniuk, Treny M.; Buchko, Greg; Reed, Jeremy; Monteleone, Bradley J.

doi:10.1177/0363546508322896

Cited by 37 publications

(31 citation statements)

References 22 publications

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“…One level 1study showed no difference in pain scores or analgesic use in the first 14 days when comparing the use of an immobilizer with no brace. 50 Other studies have rendered similar findings in examining the use of a neoprene sleeve and functional braces compared with no brace. [51][52][53] The role of functional knee bracing after ACL reconstruction has been extensively studied in the literature.…”

Section: Bracingmentioning

confidence: 71%

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: Bracingmentioning

confidence: 71%

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

“…6 We consecutively enrolled the patients in the DB ACLR group in a case series and recorded pain and medication use in the same manner as the RCT to assess appropriate provision of postoperative analgesia. We excluded patients undergoing revision surgery or reconstruction with allograft from our study.…”

Section: Methodsmentioning

confidence: 99%

A comparison of pain scores and medication use in patients undergoing single-bundle or double-bundle anterior cruciate ligament reconstruction

et al. 2014

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A comparison of pain scores and medication use in patients undergoing single-bundle or doublebundle anterior cruciate ligament reconstructionBackground: No gold standard exists for the management of postoperative pain following anterior cruciate ligament reconstruction (ACLR). We compared the pain scores and medication use of patients undergoing single-bundle (SB) or double-bundle (DB) ACLR in the acute postoperative period. Pain and medication use was also analyzed for spinal versus general anesthesia approaches within both surgery types. Methods:We assessed 2 separate cohorts of primary ACLR patients, SB and DB, for 14 days postoperatively. We used a standard logbook to record self-reported pain scores and medication use. Pain was assessed using a 100 mm visual analogue scale (VAS). Medications were divided into 3 categories: oral opioids, oral nonsteroidal anti-inflammatories and acetaminophen.Results: A total of 88 patients undergoing SB and 41 undergoing DB ACLR were included in the study. We found no significant difference in VAS pain scores between the cohorts. Despite similar VAS pain scores, the DB cohort consumed significantly more opioid and analgesia medication (p = 0.011). Patients who underwent DB with spinal anesthesia experienced significantly less pain over the initial 14-day postoperative period than those who received general anesthesia (p < 0.001). Conclusion:Adequate pain relief was provided to all ACLR patients in the initial postoperative period. Patients in the DB cohort experienced more pain, as evidenced by the significant difference in consumption of opioids and acetaminophen, than the SB cohort. Patients who underwent spinal anesthesia experienced less pain in the acute postoperative period than those who received general anesthesia.

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“…Six additional randomized controlled trials have since been published (Table II) 3,4,12-15 . Hiemstra et al 12 performed a randomized controlled trial comparing knee immobilization with no bracing following ACL reconstruction with hamstring tendon; early pain was assessed in eighty-eight patients randomized by computer into two groups. The primary outcome was patient pain self-assessed …”

Section: Postoperative Bracingmentioning

confidence: 99%

“…Since 2005, numerous studies have evaluated the safety of accelerated and brace-free rehabilitation protocols that attempt to return athletes to sports more quickly [3][4][5][6][7][8][9][10][11] . Several studies investigated the use of bracing for additional benefits such as pain control [12][13][14] . Additionally, longer-term data from previously published trials are becoming available [15][16][17] .…”

mentioning

confidence: 99%