Continuous Passive Motion Does Improve Range of Motion, Pain and Swelling After ACL Reconstruction: A Systematic Review and Meta-Analysis

Abstract

Background This systematic review and meta-analysis evaluates the results of empirical studies on the effects of CPM on rehabilitation after ACL reconstruction. The research question was: what are the effects of CPM on ROM, swelling and pain after ACL reconstruction?

Patients/Material and Methods We searched in MEDLINE, Embase, CINAHL, Cochrane and PEDro up to January 2018. Standardized mean differences (SMD) were expressed as Hedgesʼ g, in order to correct for overestimation of the true effect in small study samples. The 95% confidence intervals (95% CI) were calculated for both the individual studies and the overall weighted estimate. Outcomes were range of motion, pain and swelling.

Results Eight studies comprising 442 participants were included in the meta-analysis. Beneficial effects of CPM could be identified for the need for pain medication (Hedgesʼ g = 0.93; 95% CI = 0.41 to 1.45 during the first 24 hours after surgery), the number of PCA button pushes by the patient during the first 24 hours after surgery (MD = 31.20; 95% CI = 11.35 to 51.05), on regaining knee flexion on the third to the seventh postoperative day (MD = 11.6°; 95% CI = 1.96 to 21.33) as well as in the third to the sixth postoperative week (Hedgesʼ g = 0.93; 95% CI = 0.41 to 1.44) and on swelling of the knee in the fourth to sixth postoperative week (Hedgesʼ g = 0.77; 95% CI = 0.35 to 1.18).

Conclusion This meta-analysis suggests that CPM has beneficial effects on pain reduction during the first two postoperative days, on knee flexion during the first to the sixth postoperative weeks and on swelling between the fourth and the sixth postoperative weeks. However, the risk-of-bias scores do not allow a high level of evidence.

Zusammenfassung

Hintergrund Diese systematische Literaturübersichtsarbeit und Metaanalyse evaluierte die Ergebnisse aus empirischen Studien über die Auswirkungen von kontinuierlichen passiven Bewegungsbehandlungen (KPB) auf die Rehabilitation nach ACL-Rekonstruktion. Die Forschungsfrage war: Was sind die Auswirkungen von CPM auf ROM, Schwellungen und Schmerzen nach ACL-Rekonstruktion?

Patient/Material und Methoden Wir suchten in den Datenbanken CINAHL, Cochrane, Embase, MEDLINE, und PEDro bis Januar 2018. Standardisierte mittlere Differenzen (SMD) werden in Form von Hedgesʼ g dargestellt, um eine Überschätzung der wahren Wirkung in kleinen Studienproben zu korrigieren. Für die einzelnen Studien als auch für die gewichtete Gesamtschätzung wurden 95%-Konfidenzintervalle (95%-KI) berechnet. Outcomes waren Beweglichkeit, Schmerzen und Schwellungen.

Ergebnisse Acht Studien mit 442 Probanden wurden in diese Metaanalyse eingeschlossen. Positive Effekte von KPB konnten in Bezug i) auf Schmerzmittelgabe während den ersten 24 Stunden nach der Operation (Hedgesʼ g = 0,93; 95%-KI = 0,41 – 1,45), ii) auf PCA-Gabe vom Patienten während der ersten 24 Stunden nach der Operation (MD = 31,20; 95%-KI = 11,35 – 51,05), iii) nach wiedererlangter Knieflexionsbeweglichkeit am 3. – 7. postoperativen Tag (MD = 11,6°; 95%-KI = 1,96 – 21,33) sowie in der 3. – 6. postoperativen Woche (Hedgesʼ g = 0,93; 95%-KI = 0,41 – 1,44) und iv) bei Schwellung des Knies in der 4. – 6. postoperativen Woche (Hedgesʼ g = 0,77; 95%-KI = 0,35 – 1,18) identifiziert werden.

Schlussfolgerung Diese Metaanalyse zeigt auf, dass KPB positive Auswirkungen auf die Schmerzreduktion in den ersten beiden postoperativen Tagen, auf Knieflexion während der 1. – 6. postoperativen Woche und auf Schwellungen zwischen der 4. und 6. postoperativen Woche hat. Die Risk-of-Bias-Scores erlauben jedoch keine hohen Evidenzgrade.

Key words

continuous passive motion therapy - anterior cruciate ligament reconstruction - rehabilitation

Schlüsselwörter

kontinuierliche passive Bewegungsbehandlungen - Rekonstruktion des vorderen Kreuzbands - Rehabilitation

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