Cryotherapy . . . Skin Deep or to the Bone?
Abstract & Commentary
Synopsis: Whether applied immediately or after an hour delay, cryotherapy produced a significant drop in intraarticular temperature following knee arthroscopy.
Source: Martin SS, et al. Cryotherapy: An effective modality for decreasing intraarticular temperature after knee arthroscopy. Am J Sports Med. 2001;29(3):288-291.
Cryotherapy is commonly used in sports medicine following knee, shoulder, and ankle arthroscopy. The benefits of ice and compression have included decreasing pain and improving early postoperative motion. Prior studies have reported benefits of superficial cooling, but deep cooling has not been reported. The purpose of this study was to prospectively evaluate the intraarticular knee temperature after routine arthroscopy with and without the use of an Aircast Cryocuff.
Seventeen patients undergoing routine arthrosocopy were placed into 1 of 2 groups. Patients undergoing complex intraarticular procedures like ACL reconstruction or lateral release were not included. At the completion of the arthroscopy, skin and intraarticular probes were placed in the knee for 2 hours postoperatively. The first group had immediate postoperative cryotherapy and compression, and the second group had the same treatment instituted after a 1-hour delay. The ice water was changed every 30 minutes. Temperature was measured every minute for 2 hours before the probes were removed.
The results showed that the intraarticular temperature dropped 3° over the 2 hours in the first treatment group. In the second treatment (delayed) group the intraarticular temperature increased by 5° for the first hour but decreased 4° during the second hour when the ice water was added. Therefore, the total difference between both groups during the first hour was a 7° temperature drop.
Comment by James R. Slauterbeck, MD
The benefits of ice and compression are known to nearly everyone. Most athletes and nonathletes routinely use ice for its analgesic and anti-inflammatory effect. Physicians routinely prescribe ice and compression modalities after injury and surgery. Many have asked if the benefits of cryotherapy are more than skin deep. This study was designed to answer this question.
Several points can be gained from this simple and well-designed study. First, cryotherapy and compression effectively decreases the intraarticular temperature. Second, without the use of cryotherpy, the intraarticular environment increased in temperature. Third, a cooling effect in the intraarticular environment will occur even after a 1-hour delay in beginning cyrotherapy. In summary, a net difference of 7° was recorded between the cooled and noncooled knee at 1 hour.
So what does this mean? This study has demonstrated to me that the effects of compression and cryotherapy go far beneath the skin. Although this study does not address more complex knee surgeries, I would bet that similar findings would be noted. Although not addressed in this article, the thickness of the postoperative dressing could significantly affect the intraarticular cooling process. I routinely use compression and cryotherpy with light postoperative dressings with good results.
Dr. Slauterbeck, Associate Editor of Sports Medicine Reports, is Associate Professor, Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock.
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