Improved rehabilitation and functional outcome with dedicated joint irrigation at the end of ACL reconstruction

Authors

  • Ajeet Singh Department of Orthopaedics, RK Life Line Hospital, Sirsa, Haryana, Punjab, India
  • Rakesh Kumar Department of Orthopaedics, SMS&R, Sharda Hospital, Greater Noida, Uttar Pradesh, India
  • Rajni Ranjan Department of Orthopaedics, SMS&R, Sharda Hospital, Greater Noida, Uttar Pradesh, India
  • Avijit Mahajan Department of Orthopaedics, IVY Hospital, Hosiarpur, Punjab, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20181803

Keywords:

Anterior cruciate ligament, Visual analogue scale, Suprapatellar fullness

Abstract

Background: ACL is most common ligament injured during sports. Postoperative pain and swelling is one of the major limiting factors for the rehabilitation of ACL reconstructed patients. Cryotherapy and intra-articular bupivacaine injection are few measures to reduce the pain. One of the main reason for pain is inflammatory mediators, by joint irrigation it reduce the inflammatory mediator that reduce pain and swelling.

Methods: We treated 33 patients of ACL injury with arthroscopic ACL reconstruction from July 2015 to April 2017. Postoperative pain and swellings were assed with VAS and suprapatellar fullness. VAS assessment done on 1st day, 2nd day and 12th day and for swelling 2nd day and 12th day. We had used closed loop endobutton for femur and bioscrew for tibia. In twenty patients at the end of the surgery we used 2 liter saline for joint irrigation.

Results: As a result of wash of pro inflammatory mediators and debris, there were reduced inflammation which reduces pain and swelling. Patients who received irrigation had less VAS score and suprapatellar fullness than the other group. There was better knee flexion on 12th day.

Conclusions: Adding up a dedicated joint irrigation at the end of surgery does not deviate from standard surgical protocol. No studies have stress upon joint irrigation. It reduce the pain and swelling by reducing inflammation which gives better result.

 

Author Biographies

Ajeet Singh, Department of Orthopaedics, RK Life Line Hospital, Sirsa, Haryana, Punjab, India

Consultant and Head

Department of orthopaedic

Rakesh Kumar, Department of Orthopaedics, SMS&R, Sharda Hospital, Greater Noida, Uttar Pradesh, India

assistant professor

department of orthopaedics

Rajni Ranjan, Department of Orthopaedics, SMS&R, Sharda Hospital, Greater Noida, Uttar Pradesh, India

associate professor

department of orthopaedic

Avijit Mahajan, Department of Orthopaedics, IVY Hospital, Hosiarpur, Punjab, India

consultant

department of orthopaedic

References

Hirshman HP, Daniel DM, Miysaka K. The fate of unoperated knee ligament injuries. In: Daniel DM, Akeson W, O’Connor J, eds. Knee Ligaments: Structure, Function, Injury and Repair. Raven Press; New York; 1990: 481-503.

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33:1751-67.

Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrorsis. Sports Med. 1999;27:143-56 .

Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC. Factors involved in the development of osteoarthritis following anterior cruciate ligament surgery. Am J Sports Med. 2010;38:455-63.

Brown CH, Carson EW. Revision anterior cruciate ligament surgery. Clin Sports Med. 1999;18:109-71.

Cohen SB, Sekiya JK. Allograft safety in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26:597-605.

Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silbey M. Allograft versus autograft anterior cruciate ligament reconstruction: 3-to 5-year outcome. Clin Orthop. 1996;324:134-44.

Johnson RJ, Eriksson E, Haggmark T, et al. Five- to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop. 1984;183:122-40.

Cohn BT, Draeger RI, Jackson DW. The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med. 1989;17:344–9.

Daniel DM, Stone ML, Arendt DL. The effect of cold therapy on pain, swelling, and range of motion after anterior cruciate ligament reconstructive surgery. Arthroscopy. 1994;10:530–3.

Edwards DJ, Rimmer M, Keene GC. The use of cold therapy in the postoperative management of patients undergoing arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med. 1996;24:193–5.

Konrath GA, Lock T, Goitz HT, Scheidler J. The use of cold therapy after anterior cruciate ligament reconstruction: a prospective, randomized study and literature review. Am J Sports Med. 1996;24:629–33.

Scheffler NM, Sheitel PL, Lipton MN. Use of Cryo/Cuff for the control of postoperative pain and edema. J Foot Surg. 1992;31:141–8.

Bert J, Stark J, Maschka K. The effect of cold therapy on morbidity subsequent to arthroscopic lateral retinacular release. Orthop Rev. 1991;20:755–8.

Knight KL. Cryotherapy in Sport Injury Management. Champaign, IL: Human Kinetics; 1995.

Huebner KD, Shrive NG, Frank CB. New surgical model of post-traumatic osteoarthritis: isolated intra-articular bone injury in the rabbit. J Orthop Res. 2013;31:914–20.

Haslauer CM, Elsaid KA, Fleming BC, Proffen BL, Johnson VM, Murray MM. Loss of extracellular matrix from articular cartilage is mediated by the synovium and ligament after anterior cruciate ligament injury. Osteoarthritis Cartilage. 2013;21:1950–7.

Danieli MV, Neto AC, Herrera PA. Intra-articular bupivacaine or bupivacaine and morphine after ACL reconstruction Acta Ortop Bras. 2012;20(5):258–61.

Fincher AL, Woods GW, O'Connor DP. Intraoperative Arthroscopic Cold Irrigation Solution Does Not Affect Postoperative Pain and Swelling. J Athl Train. 2004;39(1):12–6.

Bondeson J, Blom AB, Wainwright S, Hughes C, Caterson B, van den Berg WB. The role of synovial macrophages and macrophage-produced mediators in driving inflammatory and destructive responses in osteoarthritis. Arthritis Rheum. 2010;62:647–57.

Downloads

Published

2018-04-25

Issue

Section

Original Research Articles