The effect of combined cryotherapy/compression versus cryotherapy following ACL recon in return-to-sports after 3 months

Abstract

Introduction: Morbidity following ACL reconstruction may be a key factor contributing to muscular dysfunction and influencing physical activity. While intra-operative details have been the focus of standardization within the last years, strategies reducing the morbidity such as postoperative cryotherapy have been investigated less. Goal of this study was to compare subjective and objective patient outcomes following ACL reconstruction with combined compression and cryotherapy compared with traditional cryotherapy alone. Hypotheses: We hypothesized that cryotherapy/compression will show significantly better results three months after ACL reconstruction compared to cryotherapy alone. Methods: A total of 40 Patients undergoing ACL reconstruction are prospectively randomized to be treated with cryotherapy/compression device (GameReady, CA/USA, group 1) or a cryotherapy device (Aircast Cryocuff, DJO CA/USA, group 2). ACL reconstructions were performed by a single surgeon with semitendinosus graft and standardized rehabilitation protocol. Patients were instructed to use the ice therapy devices 4 times per day for 30min. Pain management directly postoperatively was analyzed as recorded during clinical records and VAS. Follow-up was performed at 12 weeks postoperatively using visual analog scale (VAS), Lysholm knee score, Short Form 36 (SF36), and Tegner acitiy score. Additionally, a functional 'return-to-sports' analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests) and a 3d-motion analysis (myomotion, Noraxon) during bilateral drop jumps and single leg hop tests was performed. Results: VAS and comparison of the administrated painkillers showed no significant differences between the two groups. Both groups used the cryotherapy/compression device and the cryotherapy device as determined by the study protocol. At 12 weeks, there was no significant difference between the two groups with regard to Lysholm score, Tegner score, and SF-36, however there was a trend towards better scores in group 1. The was a higher range of motion in group 1 compared to group 2. Functional analysis with isokinetic strength measurements, proprioceptive test and a 3d-motion analysis revealed better functional results in patients of the group cryotherapy/compression device compared to cryotherapy alone. Conclusion: This prospective analysis of 40 patients following semitendinosus ACL reconstruction with one single surgeon implicates that the use of a cryotherapy/compression device (GameReady) showed significantly better objective patient outcomes following ACL reconstruction compared to cryotherapy alone.