Use of cryotherapy in the postoperative management of paediatric anterior cruciate ligament reconstruction: a prospective randomised controlled trial

To investigate the efficacy of cryotherapy in relieving postoperative pain and restoring knee range-of-motion (ROM) after paediatric anterior cruciate ligament reconstruction (ACLR). Patients undergoing primary ACLR were randomised into cryotherapy or non-cryotherapy groups. Those receiving cryotherapy were subjected to a standardised icing protocol. Icing schedules were used to assess compliance. Standard postoperative rehabilitation protocol was followed for both groups. Outcome measurements were visual analogue scale at rest and movement and knee ROM. Patients were assessed on postoperative day 1 (POD1), 1, 4 and 6 weeks. Twenty-one out of 42 patients received cryotherapy. Both groups were similar in demographics, surgical technique and use of intraoperative anaesthesia. Patients in the cryotherapy group reported lower overall mean pain scores throughout the study duration at rest (0.61 ± 1.70, 95% CI = 0.23-0.99 vs. 1.06 ± 2.03, 95% CI = 0.60-1.53) and on movement (2.19 ± 2.68, 95% CI = 1.59-2.79 vs. 3.13 ± 2.75, 95% CI = 2.51-3.75; P  = 0.032). Knee flexion in the cryotherapy group showed better recovery of knee flexion from week 4 onwards. Improvement of knee flexion from POD1 is statistically significant at week 6 (98.7 ± 19.1°, 95% CI = 89.5-107.9 vs. 65.4 ± 49.9°, 95% CI = 42.7-88.1; P  = 0.010) and overall mean (71.2 ± 35.9°, 95% CI = 61.2-81.1 vs. 45.3 ± 55.5°, 95% CI = 30.4-60.2; P  = 0.005). The cryotherapy group reported statistically significant better degree of overall mean knee extension (1.2 ± 3.3°, 95% CI = 0.5-2.0 vs. 2.6 ± 4.6°, 95% CI = 1.6-3.7; P  = 0.032). The use of cryotherapy in postoperative ACLR recovery in paediatrics is a simple yet effective measure resulting in short-term pain relief and improvement in knee flexion.

The Effect of Local Heat Therapy versus Cold Rub Gel on Pain and Joint Functions in Patients with Knee Osteoarthritis

This study was compared the effect of local heat therapy versus cold rub gel on pain and joint function in patients with knee osteoarthritis. One hundred seventeen patients with knee osteoarthritis were randomly assigned to cold rub gel, local heat therapy, and control group. Data were collected by knee injury and osteoarthritis outcome score at a week prior to the interventions and on weeks of 1, 2, 3, and 4 of the interventions. A significant difference was found between the three groups in terms of pain severity (p = .001), joint symptoms (p = .001), ADL function (p = .001), Sport and Recreation function (p = .001), except Knee related QOL (p = .3). Cold rub gel and heat therapy were both effective in improving pain and joint function in patients with knee osteoarthritis.

KNEE PROPRIOCEPTION MAY BE ALTERED BY TREATMENT IN ATHLETES SUFFERING FROM DELAYED ONSET MUSCLE SORENESS

Delayed onset muscle soreness (DOMS) is a very common musculoskeletal problem in athletes involved in extreme competitions. The aim of this study is to compare the effect of diathermy, sham diathermy and massage on the knee proprioception of athletes treated for DOMS. Forty athletes were enrolled after the second day of a demanding ski mountaineering race. They were randomly assigned to four groups: no treatment [Formula: see text], massage [Formula: see text], diathermy [Formula: see text], and sham diathermy [Formula: see text]. The knee reposition error was measured after the treatments in order to assess knee proprioception. Significant differences between the diathermy and sham diathermy groups were found ([Formula: see text]) with an absolute effect size of [Formula: see text]. No other significant differences were found among groups. This means that diathermy has a negative impact on joint proprioception and can be explained by the spindle desensitization consequent to deeper tissue heating. This information can be important in the DOMS management of athletes, since an altered proprioception may interfere with the athlete’s performance and can increase the risk of injury.