Orthopaedic Application of Cryotherapy: A Comprehensive Review of the History, Basic Science, Methods, and Clinical Effectiveness
Kunkle BF, Kothandaraman V, Goodloe JB, Curry EJ, Curry EJ, Friedman RJ, Li X, Li X, Eichinger JK
JBJS reviews · 34 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Systematic review (classified by our AI screen)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2021-01-01 · JBJS Rev · vol. 9 · issue 1 · p. e20.00016
- Publisher
- Lippincott Williams & Wilkins
- Cited
- 49 citations · more than 89% of similar papers · 2.3× the field average
- References
- 105 works
- Access
- Paywalled
- Research areas
- Exercise and Physiological Responses · Dermatological and COVID-19 studies · Thermal Regulation in Medicine
- Keywords
- Medicine, Cryotherapy, MEDLINE, Physical therapy, Physical medicine and rehabilitation, Surgery
- MeSH
- humans, range of motion, articular, treatment outcome, cryotherapy, orthopedics, postoperative pain
7 authors
From US
- Bryce F. KunkleMedical University of South Carolina
- Venkatraman KothandaramanMedical University of South Carolina
- Jonathan Brett GoodloeMedical University of South Carolina
- Emily J. CurryBoston University
- Richard Joel FriedmanMedical University of South Carolina
- Xinning LiBoston University
Abstract
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Cold therapy, also known as cryotherapy, includes the use of bagged ice, ice packs, compressive cryotherapy devices, or whole-body cryotherapy chambers. Cryotherapy is commonly used in postoperative care for both arthroscopic and open orthopaedic procedures.
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Cryotherapy is associated with an analgesic effect caused by microvasculature alterations that decrease the production of inflammatory mediators, decrease local edema, disrupt the overall inflammatory response, and reduce nerve conduction velocity.
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Postoperative cryotherapy using bagged ice, ice packs, or continuous cryotherapy devices reduced visual analog scale pain scores and analgesic consumption in approximately half of research studies in which these outcomes were compared with no cryotherapy (11 [44%] of 25 studies on pain and 11 [48%] of 23 studies on opioids). However, an effect was less frequently reported for increasing range of motion (3 [19%] of 16) or decreasing swelling (2 [22%] of 9).
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Continuous cryotherapy devices demonstrated the best outcome in orthopaedic patients after knee arthroscopy procedures, compared with all other procedures and body locations, in terms of showing a significant reduction in pain, swelling, and analgesic consumption and increase in range of motion, compared with bagged ice or ice packs.
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There is no consensus as to whether the use of continuous cryotherapy devices leads to superior outcomes when compared with treatment with bagged ice or ice packs. However, complications from cryotherapy, including skin irritation, frostbite, perniosis, and peripheral nerve injuries, can be avoided through patient education and reducing the duration of application.
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Future Level-I or II studies are needed to compare both the clinical and cost benefits of continuous cryotherapy devices to bagged ice or ice pack treatment before continuous cryotherapy devices can be recommended as a standard of care in orthopaedic surgery following injury or surgery.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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