Effects of Cold and Compression Dressings on Early Postoperative Outcomes for the Arthroscopic Anterior Cruciate Ligament Reconstruction Patient
Abstract & Commentary
Synopsis: The compression component of the cryo/cuff compression dressing is the more influential portion of cold and compression.
Source: Dervin GF et al. Effects of cold and compression dressings on early postoperative outcomes for the arthroscopic anterior cruciate ligament reconstruction patients. J Orthop Sports Phys Ther 1998; 27(6):403-406
This is a prospective study in which 78 patients who were treated with primary anterior cruciate ligament reconstruction by the senior author between March of 1995 and January of 1996 were randomized into two groups. The purpose of this study was to evaluate the effects of cryo/cuff (Aircast, Summit, NJ) compression plus cold versus just cryo/cuff compression. One group had a cryo/cuff dressing applied with ice water, while the other had a cryo/cuff applied with only room temperature water. Outcome measures included total wound drainage, pain as recorded on a 100-mm, visual analog scale at 24 hours (0=no pain and 100=worst possible pain), and total intravenous (mg of morphine) and oral (number of 30 mg codeine tablets) analgesic requirement. Time to discharge was also recorded. Results indicated that there was no significant difference between the two groups with respect to wound drainage, reported pain, analgesic requirement or time in hospital. The authors concluded that the compression component of the cryo/cuff compression dressing is the more influential portion of cold and compression.
Comment by Clayton Holmes, EdD, PT, ATC
The authors have shown that the compression component of the cryo/cuff device may indeed be more important than the cold component. This may be applied more broadly not just to postsurgical but perhaps to postinjury treatment utilizing compression and ice as well. It has long been held that cryotherapy is an effective means of treating a variety of musculoskeletal injuries. This study seems to indicate that, with regard to variables related to swelling, the compression may indeed be at least as important as cold. The authors also bring up an interesting point: perhaps cold is at times detrimental. In fact, previous literature has reported increases in swelling secondary to cold treatment of uninjured ankles.1 Nerve injury can result from cryotherapy as well.2,3 This line of research has the potential to significantly affect the way acute athletic injuries are treated. However, more research needs to be done in this area before I would suggest people move away from cryotherapy as part of a treatment program for acute injuries. It is also important to note, as the authors pointed out, Mindrebo and Shelbourne have demonstrated decreased calf venous outflow with the application of the cryo/cuff device.4 This may imply that there is an increased risk of deep venous thrombosis with the application of severe compression.
References
1. Farry PJ, et al. Ice Treatment of Injured Ligaments: An experimental model. N Z Med J 1980; 91:12- 14
2. Bassett FH III et al. Cryotherapy-introduced Nerve Injury. Am J Sports Med 1992; 20(5):516- 518
3. Prez D et al. Cryotherapy and Nerve Palsy. Am J Sports Med 1981; 9(4):256-257
4. Mindrebo N et al. Outpatient percutaneous screwfixation of the acute Jones fracture. Am J Sports Med 1993; 21(5):720-3
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