Abstract
Purpose
To obtain in vivo data about intra- and extra-articular knee temperatures to assess the effectiveness of two cryotherapeutic methods—conventional cooling with gel-packs and computer controlled cryotherapy following anterior cruciate ligament (ACL) reconstructive surgery.
Methods
Twenty patients were arbitrarily assigned for cryotherapy after ACL reconstruction: 8 patients with frozen gel-packs and 12 patients with computer controlled cryotherapy with constant temperatures of the cooling liquid in the knee pads. The treatment was performed for 12 h. Temperatures were measured with two thermo sensors in catheters placed intraarticularly and subcutaneously, four sensors on the skin and one sensor under protective bandage, every second for 16 h after surgery.
Results
In the first 2 h of treatment, there were no significant differences (n.s.) between the groups in temperatures in the intracondylar notch. After 4 h of cryotherapy, the temperatures were significantly lower on the skin (24.6 ± 2.8 and 31.4 ± 1.3 °C, p < 0.01) and in the subcutaneous tissue (28.6 ± 5.7 and 34.6 ± 1.4 °C, p = 0.01), and the difference between the temperature in the intracondylar notch and the subcutaneous tissue was significantly greater (4.0 ± 3.0 and 0.8 ± 0.6 °C, p = 0.01) in the computer controlled cryotherapy group compared to the gel-pack group.
Conclusions
The cooling effect of the arthroscopy irrigation fluid on the knee temperature is evident in the first 2 h of treatment. The energy extraction is significantly more effective and controllable by computer controlled cryotherapy than with frozen gel-packs.
Level of evidence
Prospective comparative study, Level II.
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References
Block JE (2010) Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. Open J Sports Med 1:105–113
Bugaj R (1975) The cooling, analgesic, and rewarming effects of ice massage on localized skin. Phys Ther 55:11–19
Cohn BT, Draeger RI, Jackson DW (1989) The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 17:344–349
Dahlstedt L, Samuelson P, Dalén N (1996) Cryotherapy after cruciate knee surgery: skin, subcutaneous and articular temperatures in 8 patients. Acta Orthop Scand 67:255–257
Daniel DM, Stone ML, Arendt DL (1994) The effect of cold therapy on pain, swelling, and range of motion after anterior cruciate ligament reconstructive surgery. Arthroscopy 10:530–533
Dervin GF, Taylor DE, Keene GC (1998) Effects of cold and compression dressings on early postoperative outcomes for the arthroscopic anterior cruciate ligament reconstruction patient. J Orthop Sports Phys Ther 27:403–406
Glenn RE Jr, Spindler KP, Warren TA, McCarty EC, Secic M (2004) Cryotherapy decreases intraarticular temperature after ACL reconstruction. Clin Orthop Relat Res 421:268–272
Grana W (1994) Cold modalities. In: DeLee JC, Drez D (eds) Orthopaedic sports medicine: principles and practice. WB Saunders, Philadelphia, pp 203–207
Knight KL (1985) Cryotherapy: theory, technique and physiology. Education Division, Chattanooga Corporation, Chattanooga
Konrath GA, Lock T, Goitz HT, Scheider J (1996) The use of cold therapy after anterior cruciate ligament reconstruction. Am J Sports Med 24:629–633
Martin SS, Spindler KP, Tarter JW, Detwiler K, Petersen HA (2001) Cryotherapy: an effective modality for decreasing intraarticular temperature after knee arthroscopy. Am J Sports Med 29:288–291
Martin SS, Spindler KP, Tarter JW, Detwiler KB (2002) Does cryotherapy affect intraarticular temperature after knee arthroscopy? Clin Orthop Relat Res 400:184–189
McGuire DA, Hendricks SD (2006) Incidences of frostbite in arthroscopic knee surgery postoperative cryotherapy rehabilitation. Arthroscopy 22:1141e1–1141e6
Ohkoshi Y, Ohkoshi M, Nagasaki S, Ono A, Hashimoto T, Yamane S (1999) The effect of cryotherapy on intraarticular temperature and postoperative care after anterior cruciate ligament reconstruction. Am J Sports Med 27:357–362
Oosterveld FG, Rasker JJ (1994) Effects of local heat and cold treatment on surface and articular temperatures of arthritic knees. Arthritis Rheum 37:1578–1582
Schaubel HJ (1946) The local use of ice after orthopedic procedures. Am J Surg 72:711–714
Schröder D, Pässler HH (1994) Combination of cold and compression after knee surgery. A prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2:158–165
Shelbourne KD, Rubinstein RA Jr, McCarroll JR, Weaver J (1994) Postoperative cryotherapy for the knee in ACL reconstructive surgery. Orthopedics 2:165–170
Trobec R, Šterk M, AlMawed S, Veselko M (2008) Computer simulation of topical knee cooling. Comput Biol Med 38:1076–1083
Waegener R&D, Belgium, http://www.waegener.com
Zaffagnini S, Iacono F, Petitto A, Loreti I, Fu FH, Marcacci M (1998) Cryo/Cuff use after arthroscopic surgery: effect on knee joint temperature. Am J Knee Surg 11:203–207
Acknowledgments
We thank the staff of the University Medical Centre Ljubljana, Department of Traumatology, Slovenia, for their generous support, and WAEGENER R&D NV, Belgium, for the cTreatment® device and partial funding. We also thank MSc Ivan Tomasić for his assistance in the statistical analysis. We acknowledge the remaining financial support from the state budget by the Slovenian Research Agency under the Grant P2-0095.
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Rashkovska, A., Trobec, R., Avbelj, V. et al. Knee temperatures measured in vivo after arthroscopic ACL reconstruction followed by cryotherapy with gel-packs or computer controlled heat extraction. Knee Surg Sports Traumatol Arthrosc 22, 2048–2056 (2014). https://doi.org/10.1007/s00167-013-2605-x
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DOI: https://doi.org/10.1007/s00167-013-2605-x