|Beitragstitel||Continuous passive motion does improve range of motion, pain and swelling after ACL reconstruction: a systematic review and meta-analysis|
Introduction: This systematic review and meta-analyses evaluated 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?
Methods: We searched in MEDLINE, Embase, CINAHL, Cochrane and PEDro up to January 2018. Standardized mean differences (SMD) and expressed as Hedges' 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. Outcome were range of motion, pain and swelling.
Results: Eight studies comprising 442 participants were included into the meta-analysis. Beneficial effects of CPM could be identified concerning the need for pain medication (Hedges' g = 0.93; 95% CI = 0.41 to 1.45 during the first 24 hours after surgery; Hedges' g = 0.74; 95% CI = 0.23 to 1.25 on the second postoperative day), the amount 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 (Hedges' g = 0.93; 95% CI = 0.41 to 1.44) and on swelling of the knee in the fourth to the sixth postoperative week (Hedges' 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.
Key words: continuous passive motion, CPM, anterior cruciate ligament, ACL
Trial registration: CRD42014015077