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

Theo Jaspers; Jan Taeymans; Anja Hirschmüller; Heiner Baur; Roger Hilfiker; Slavko Rogan

doi:10.1055/a-0710-5127

Zeitschrift für Orthopädie und Unfallchirurgie, Inhaltsverzeichnis

Z Orthop Unfall 2019; 157(03): 279-291
DOI: 10.1055/a-0710-5127

Review

Georg Thieme Verlag KG Stuttgart · New York

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

Kontinuierliche passive Bewegungsschiene verbessert den Bewegungsumfang, Schmerz und Schwellung bei ACL-Rekonstruktion: Eine systematische Literaturübersichtsarbeit und Metaanalyse

Theo Jaspers

¹Therapien, Siloam Klinik, Bern, Switzerland

,

Jan Taeymans

²Departement Gesundheit, Berner Fachhochschule, Bern, Switzerland

,

Anja Hirschmüller

³Sport, Altius Swiss Sportmed Center AG, Rheinfelden, Switzerland

,

Heiner Baur

²Departement Gesundheit, Berner Fachhochschule, Bern, Switzerland

,

Roger Hilfiker

⁴Institute of Health, University of Applied Sciences Valais-Wallis, Leukerbad, Germany

,

Slavko Rogan

²Departement Gesundheit, Berner Fachhochschule, Bern, Switzerland

⁵Academy of Physiotherapy and Trainingseducation, Grenzach-Wyhlen, Germany

› Institutsangaben

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

Volltext

Referenzen

References
1 Salter RB, Bell RS, Keeley FW. The protective effect of continuous passive motion on living articular cartilage in acute septic arthritis: an experimental investigation in the rabbit. Clin Orthop Relat Res 1981; 159: 223-247
2 OʼDriscoll SW, Kumar A, Salter RB. The effect of continuous passive motion on the clearance of a hemarthrosis from a synovial joint: an experimental investigation in the rabbit. Clin Orthop Relat Res 1983; 176: 305
3 Salter RB. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res 1989; 242: 12-25
4 Salter RB, Hamilton HW, Wedge JH. et al. Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study. J Orthop Res 1983; 1: 325-342
5 OʼMeara PM, OʼBrien WR, Henning CE. Anterior cruciate ligament reconstruction stability with continuous passive motion. The role of isometric graft placement. Clin Orthop Relat Res 1992; 201-209
6 Smith TO, Davies L. The efficacy of continuous passive motion after anterior cruciate ligament reconstruction: a systematic review. Phys Ther Sport 2007; 8: 141-152
7 Lobb R, Tumilty S, Claydon LS. A review of systematic reviews on anterior cruciate ligament reconstruction rehabilitation. Phys Ther Sport 2012; 13: 270-278
8 Egger M, Zellweger-Zähner T, Schneider M. et al. Language bias in randomised controlled trials published in English and German. Lancet 1997; 350: 326-329
9 Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration; 2011. Online: https://handbook-5-1.cochrane.org/ last access: 11.09.2018
10 Knapik DM, Harris JD, Pangrazzi G. et al. The basic science of continuous passive motion in promoting knee health: a systematic review of studies in a rabbit model. Arthroscopy 2013; 29: 1722-1731
11 Shoemaker S, Skyhar M, Simmons T. Orthopaedic rehabilitation. 2nd ed.. ed. London: Churchill Livingstone; 1992
12 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8: 336-341
13 Engström B, Sperber A, Wredmark T. Continuous passive motion in rehabilitation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1995; 3: 18-20
14 Higgins JPT, Green S. eds. Cochrane Handbook for Systematic Reviews of Interventions. New Jersey, USA: John Wiley & Sons, Inc.; 2011
15 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
16 Terzi R, Gultekin A, Atlihan D. The effect of continuous passive motion implementation after anterior cruciate ligament reconstruction. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2013; 59: 314-318
17 Porzig F, Krüger-Franke M, Kugler A. et al. Effekte der CPM-Behandlung nach operativ versorgter isolierter vorderer Keuzbandruptur. Sport-Orthopädie-Sporttraumatologie 2007; 23: 193-198
18 Bizzini M, Caporaso F, Drobny T. et al. Post-operative rehabilitation following anterior cruciate ligament reconstruction – active vs. passive movement device [German]. Krankengymnastik 2002; 54: 740-744
19 McCarthy MR, Yates CK, Anderson MA. et al. The effects of immediate continuous passive motion on pain during the inflammatory phase of soft tissue healing following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 1993; 17: 96-101
20 Noyes FR, Mangine RE, Barber S. Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 1987; 15: 149-160
21 Rigon A, Viola R, Lonedo F. Continuous passive motion in reconstruction of the anterior cruciate ligament. J Sport Traumatol 1993; 15: 187-192
22 Witherow GE, Bollen SR, Pinczewski LA. The use of continuous passive motion after arthroscopically assisted anterior cruciate ligament reconstruction: help or hindrance?. Knee Surg Sports Traumatol Arthrosc 1993; 1: 68-70
23 Yates CK, McCarthy MR, Hirsch HS. et al. Effects of continuous passive motion following ACL reconstruction with autogenous patellar tendon grafts. J Sport Rehabil 1992; 1: 121-131
24 Rogan S, Hilfiker R, Schenk A. et al. Effects of whole-body vibration with stochastic resonance on balance in persons with balance disability and falls history – a systematic review. Res Sports Med 2014; 22: 294-313
25 Jaggi U, Joray CP, Brulhart Y. et al. [Injuries in the Martial Arts Judo, Taekwondo and Wrestling – A Systematic Review]. Sportverletz Sportschaden 2015; 29: 219-225
26 Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. The Cochrane Database Syst Rev 2010; (02) CD004260