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Combination of cold and compression after knee surgery

A prospective randomized study

  • Clinical and Biomechanical Papers
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The objective of this study was to investigate the effect of continuous long-term application of a combined cooling and compression system (Cryo/Cuff, Aircast Inc., Summit. New Jersey, USA) on postoperative swelling, range of motion (ROM), pain, consumption of analgesics, and return of function after anterior cruciated ligament (ACL) reconstruction. We compared the cold-compression system with traditional ice therapy. There were 44 patients in the series (aged 15–40 year_ who were randomly assigned to a control group (ICE) or a study group (CC). The ICE group consisted of 23 patients (aged 24.2±4.5 years); the CC group consisted of 21 patients (aged 24.8±5.6 years). The ICE group received ice bags postoperatively; the CC group was provided with the Cryo/Cuff during the 14-day hospital stay. Girth, ROM, pain score (visual analog scale), and consumption of analgesics were determined on postoperative days 1, 2, 3, 6, 14, and 28. Twelve weeks after surgery, isokinetic testing was performed, and the functional knee score was determined. In the CC group, significantly less swelling was observed (P<0.035). These patients also reported less pain and had a significantly reduced consumption of analgesics (P<0.04). On all examination days, ROM in the CC group was up to 17° greater than in the ICE group (P<0.02). The functional knee score was singificantly increased in the CC group (P=0.025). The results from our study document the advantages of conitnous cold-compression therapy over cold alone following ACL reconstruction

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References

  1. Abramson DI, Chu LSW, Tuck S Jr et al (1966) Effect of tissue temperature and blood flow on motor nerve conduction velocity. JAMA 198: 1082–1988

    Google Scholar 

  2. Airaksinen O, Kolari PJ, Miettinen H (1990) Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains. Arch Phys Med Rehabil 71: 380–383

    Google Scholar 

  3. Akeson WH, Amiel D, Abel MF et al. (1987) Effects of immobilization on joints. Clin Orthop 219: 28–37

    Google Scholar 

  4. Allen FM, Crossman LW, Hurley V et al. (1942) Refrigeration anesthesia. J Int Coll Surg 5: 125–131

    Google Scholar 

  5. Arnott J (1847) On indigestion; its pathology and treatment by the local application of uniform and continuous heat and moisture and an account of an improved mode of applying heat or cold in irritative and inflammatory diseases. Churchill, London

    Google Scholar 

  6. Arnott J (1848) On cold as a means of producing local insensibility. Lancet II: 98

    Google Scholar 

  7. Bankoff G (1946) The conquest of pain—the story of anesthesia. MacDonald, London, p 49

    Google Scholar 

  8. Bartholini T (1661) De nivis uso medico. Haubold, Kopenhagen, pp 132–133

    Google Scholar 

  9. Basset FH III, Kirkpatrick JS, Engelhardt DL et al. (1992) Cryotherapy-induced nerve injury. Am J Sports Med 20: 516–518

    Google Scholar 

  10. Beste KW, Essiger H (1984) Ultraschall-Doppler-Analyse der arteriellen Blutströmung vor und nach Kryotherapie. Z Rheumatol 43: 66–74

    Google Scholar 

  11. Bierman W (1955) Therapeutic use of cold. JAMA 157: 1189

    Google Scholar 

  12. Bonnet A (1847) Uber die Krankheiten der Gelenke. Kollmann, Leipzig

    Google Scholar 

  13. Bonnet A (1864) Neuere Erfahrungen auf dem Gebiete der Gelenkkrankheiten. Kollmann, Leipzig

    Google Scholar 

  14. Boone DC, Azen SP, Lin BS et al. (1978) Reliability of goniometric measurement. Phys. Ther 58: 1355–1360

    Google Scholar 

  15. Borgia, JF, Horvath SM (1980) Refiex cardiac effects of local cutaneous cold exposure in dogs. Am J Physiol 239: H 114–120

    Google Scholar 

  16. Bovens AMPM, Baak MAv, Vrencken JGPM et al. (1990) Variability and reliability of joint measurements. Am J Sport 18: 58–63

    Google Scholar 

  17. Cohn BT, Draeger RI, Jackson DW (1989) The effects of cold therapy in the psotoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 17: 344–349

    Google Scholar 

  18. Collins K, Storey M, Peterson K (1986) Peroneal nerve palsy after cryotherapy. Physician Sports Med 14: 105–108

    Google Scholar 

  19. Coté D, Prentice WE Jr, Hooker DN et al. (1988) Comparison of three treatment procedures for minimizing ankle sprain swelling. Phys Ther 68: 1072–1076

    Google Scholar 

  20. Danner TEK, Bernett P (1990) Tiefe Beinvenenthrombosen nach Knie-und Sprunggelenksverletzungen. Dtsch Z Sportmed 41: 428–435

    Google Scholar 

  21. Drez D, Faust DC, Evans JP (1981) Cryotherapy and nerve palsy. Am J Sports Med 9: 256–257

    Google Scholar 

  22. Esch PM, Gerngroß H, Fabian A (1989) Postoperative Schwellungsreduktion. Objektive Schwellungsmessung am oberen Sprunggelenk unter Serrapeptase—eine prospektive Studie. Fortschr Med 107: 115–118

    Google Scholar 

  23. Farry PJ, Prentice NG, Hunter AC et al. (1980) Ice treatment of injured ligaments: an experimental model. NZ Med J 91: 12–14

    Google Scholar 

  24. Flandry F, Hunt JP, Terry GC et al. (1991) Analysis of subjective knee complaints using visual analog scales. Am J Sports Med 19: 112–118

    Google Scholar 

  25. Fruhstorfer H (1990) Nozizeption und postoperativer Schmerz. In: Lehmann KA (ed) Der postoperative Schmerz. Springer, Berlin Heidelberg New York, pp 21–30

    Google Scholar 

  26. Fuchs R (1902) Geschichte der Heilunde bei den Griechen: In. Neuburger M, Pagel J (eds) Handbuch der Geschichte der Medizin. Band 1. Altertum und Mittelalter. Fischer. Jena, pp 153–402

    Google Scholar 

  27. Furnas DW (1965) Topical refrigeration and frost anesthesia. Anesthesiology 26: 344–347

    Google Scholar 

  28. Gardner AMN, Fox RH, Lawrence C et al. (1990) Reduction of posttraumatic swelling and compartment pressure by impulse compression of the foot. J Bone Joint Surg [Br] 72: 810–815

    Google Scholar 

  29. Gibson T (1950) Surface refrigeration anesthesia for cutting split-skin grafts. Br J Plast Surg 3: 6–11

    Google Scholar 

  30. Greene MA, Boltax AJ, Lustig G et al. (1965) Circulatory dynamics during the cold pressor test. Am J Cardiol 16: 54–60

    Google Scholar 

  31. Grood ES, Suntay WJ, Noyes FR et al. (1984) Biomechanics of the knee-extension exereise. J Bone Joint Surg [Am] 66: 725–733

    Google Scholar 

  32. Haeser H (1875) Lehrbuch der Geschichte der Medizin.Band 1. Geschichte der Medizin in Altertum und Mittelalter. Difft. Jena, pp 62–234

    Google Scholar 

  33. Harris ED Jr, McCroskery A (1974) The influence of temperature and fibril stability on degradation of cartilage collagen by rheumatoid synovial collgenase. N Engl J Med 290: 1–6

    Google Scholar 

  34. Hartviksen K (1962) Ice therapy in spasticity. Acta Neurol Scand 38 [Suppl 3]: 79–84

    Google Scholar 

  35. Hazarika EZ, Knight MTN, Frazer-Moodie A (1979) The effect of intermitent pneumatic compression on the hand after fasciectomy. Hand 11: 309–314

    Google Scholar 

  36. Helfreich F (1905) Geschiehte der Chirurgie. In: Neuburger M, Pagel J (eds) Handbuch der Geschichte der Medizin. Band 3. Neuere Zeit. Fischer, Jena

    Google Scholar 

  37. Husni EA, Ximenes JOC, Hamilton FG (1968) Pressure bandaging of the lower extremity. JAMA 206: 2715–2718

    Google Scholar 

  38. Irying GA, Noakes TD (1985) The protective role of local hypothermia in tourniquet-induced ischemia of muscle. J Bone Joint Surg [Br]: 297

  39. Johnson DJ, Moore S, Moore J et al (1979) Effect of cold submersion on intramuscular temperature of the gastronemius muscle. Phys. Ther 59: 1238–1242

    Google Scholar 

  40. Kellet J (1986) Acute soft tissue injuries—a review of the literature. Med Sci Sport Exerc 18: 489–500

    Google Scholar 

  41. Kern H, Fessl L, Tranavsky G et al. (1984) Dryotherapie. Das Verhalten der Gelenktemperature unter Eisapplikation—Grundlage für die praktische Anwendung. Wien Klin Wochenschr 96: 832–837.

    Google Scholar 

  42. Knapik JL, Bauman CL, Jones BH et al. (1991) Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med 19: 76–81

    Google Scholar 

  43. Knight KL (1985) Cryotherapy: theory, technique and physiology. Chattanooga Corporation. Chattanooga, Tennessee

    Google Scholar 

  44. Knight KL, Londeree BR (1980) Comparison of blood flow in the ankle of uninjured subjects during therapeutic applications of heat, cold, and exercise. Med Sci Sports Exerc 12: 76–80

    Google Scholar 

  45. Larrey DJ (1812) Mémories de chirurgie militire et campagnes. Smith, Paris

    Google Scholar 

  46. Lavelle BE, Snyder M (1985) Differenital conduction of cold through barriers. J Adv Nurs 10: 55–61

    Google Scholar 

  47. LeBlane A, Gogia P, Schneider V et al. (1988) Calf muscle area and strength changes after five weeks of horizontal bed rest. Am J Sports Med 16: 624–629

    Google Scholar 

  48. Lehmann KA (1990) On-demand-Analgesie. In: Lehmann KA (ed) Der postoperative Schmerz. Springer, berlin Heidelber New York, pp 237–265

    Google Scholar 

  49. Liman W, Fricke R, Taghawinejad M et al. (1979) Arterielle durchblutung unter Kryotherapie bei chronischer Polyarthritis. Z Phys Med Baln Med Klin 11: 196–201

    Google Scholar 

  50. Löffler G., Petrides PE, Weiss L et al. (1979) Physiologische Chemie. Springer, Berlin Heidelberg New York, p 171

    Google Scholar 

  51. Matsen FA III, Krugmire RB Jr (1974) The effect of externally applied pressure on postfracture swelling. J Bone Joint Surg [Am] 56: 1586–1591

    Google Scholar 

  52. Matsen FA III, Questad K, Matsen AL (1975) The effect of tocal cooling on post-fracture swelling. Clin Orthop 109: 201–206

    Google Scholar 

  53. McMaster WC, Liddle S (1980) Cryotherapy influence on posttraumatic limb edema. Clin Orthop 150: 283–287

    Google Scholar 

  54. Meeusen R, Lievens P (1986) The use of cryotherapy in sports injuries. sprots Med 3: 398–414

    Google Scholar 

  55. Münst P, Bonnaire F, Kuner EH (1988) Der Effekt postoperativer Kältetherapie in der Gelenkchirurgie mit einem neuartigen Kühlgerät, Unfallchirurgie 14: 224–230

    Google Scholar 

  56. Nielsen HV (1983) External pressure-blood flow relations during limb compression in man. Acta Physiol Scand 119: 253–260

    Google Scholar 

  57. Nielsen HV (1983) Arterial pressure-blood flow relations during limb elevation in man. Acta Physiol Scand 118: 405–413

    Google Scholar 

  58. Noyes FR, McGinniss GH (1985) Controversy about treatment of the knee with anterior cruciate laxity. Clin Orthop 198: 67–76

    Google Scholar 

  59. Noyes FR, Mangine RE, Barber SD (1987) Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 15: 149–160

    Google Scholar 

  60. Noyes FR, Mooar LA, Barber SD (1991) The assessment of work-related activities and limitations in knee disorders. Am J Sports Med 19: 178–188

    Google Scholar 

  61. O'Driscoll SW, Kumar A, Salter RB (1983) The effect of continuous passive motion on the clearance of a hemarthrosis from a synovial joint: an experimental investigation in the rabbit. Clin Orthop 176: 305–311

    Google Scholar 

  62. Oosterveld FG, Rasker JJ, Jacobs JW et al. (1992) The effect of local heat and cold therapy on the intraarticular and skin surface temperature of the knee. Arthritis Rheum 35: 146–151

    Google Scholar 

  63. Quillen WS, Roullier LH (1982) Initial managment of acute ankle sprains with raid pulsed pneumatic compression and cold. Sports Phys Ther 4: 39–43

    Google Scholar 

  64. Robinson V (1950) Victory over pain—a history of anesthesia. Schuman. New York, pp 40–301

    Google Scholar 

  65. Sachs RA, Daniel DM, Stone ML et al. (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sprorts Med 17: 760–765

    Google Scholar 

  66. Schaubel HJ (1946) Thedocal use of ice after orthopaedic procedures. Am J Surg 72: 711–714

    Google Scholar 

  67. Schmidt KL, Mäurer R, Rusch D (1979) Zur Wirkung örtlicher Wärme-und Kälteanwendungen auf die Hauttemperatur am Kniegelenk. Z Rheumatol 38: 213–219

    Google Scholar 

  68. Seto JL, Orofino AS, Morrissey MC et al. (1988) Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction. Am J Sprots Med 16: 170–180

    Google Scholar 

  69. Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18: 292–299

    Google Scholar 

  70. Shelbourne KD, Wilckens JH, Nollabashy A et al. (1991) Artinrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 19: 332–336

    Google Scholar 

  71. Shelbourne KD, Rubinstein RA, McCarroll JR et al. (1994) Postoperative cryotherapy for the knee in ACL reconstructive surgery. Orthop Int 2: 165–170

    Google Scholar 

  72. Spencer JD, Hayes KC, Alexander IJ (1984) Knee joint effusion and quadriceps reflex inhibition in man. Arch Phys Med Rehabil 65: 171–177

    Google Scholar 

  73. Svanes K (1964) The influence of deep hypothermia on the formation of cellular exudate in acute inflammation in mice. Acta Anaesthesiol Scand 8: 143–156

    Google Scholar 

  74. Svanes K (1964) The influence of deep hypothermia on the formation of fluid exudate in acute inflammation in mice. Acta Anaesthesiol Scand 8: 157–156

    Google Scholar 

  75. Swanson AB, Livengood LC, Sattel AB (1991) Local hypothermia to prolong safe tourniquet time. Clin Orthop 264: 200–208

    Google Scholar 

  76. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198: 43–49

    Google Scholar 

  77. Thorsson O, Hemdal B, Lilja B et al. (1987) The effect of external pressure on intramuscular blood flow at rest and after running. Med Sci Sports Exere 19: 469–473

    Google Scholar 

  78. Thorsson O, Lilja B, Ahlgren L et al (1985) The effect of local cold application on intramuscular blood flow at rest and after running. Med Sci Sport exerc 17: 710–713

    Google Scholar 

  79. Troyer H (1975) The effect of short-term immobilization on the rabbit knee joint cartilage. Clin Orthop 107: 249–257

    Google Scholar 

  80. van Royen BJ, O'Driscoll SW, Dhert WJ (1986) A comparison of the effects of immobilization and continous passive motion on surgical wound healing in mature rabbits. Plast Reconstr Surg 78: 360–368

    Google Scholar 

  81. Wright JG, Araki CT, Belkin M et al (1989) Postischemic hypothermia diminishes skeletal muscle reperfusion edema. J Surg Res 47: 389–396

    Google Scholar 

  82. Wülker N, Kohn D, Siebert WE et al (1991) Die Bedeutung des Aktivitäts-Scores bei der Bewertung von Kniebandrekonstruktionen. Sportverletz Sportschaden 5: 130–134

    Google Scholar 

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Author notes

  1. H. H. Pässler

    Present address: Atos Klinik, Heidelberg, Germany

Authors and Affiliations

  1. Sportklinik, Taubenheimstrasse 8, D-70372, Stuttgart, Germany

    D. Schröder & H. H. Pässler

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  1. D. Schröder
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  2. H. H. Pässler
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The study was conducted at the Kreiskrankenhaus Bopfingen, Germany

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Schröder, D., Pässler, H.H. Combination of cold and compression after knee surgery. Knee Surg, Sports traumatol, Arthroscopy 2, 158–165 (1994). https://doi.org/10.1007/BF01467918

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