Cold Therapy Following Knee Arthroscopy
Typically, patients who undergo knee arthroscopy for a medial meniscus tear recover within a period of one to two months. They generally use crutches for several days, narcotic analgesics for several days or weeks, and follow a home rehab program with the expectation that range of motion will return to normal within a one week or so following the surgery. Routine postoperative recommendations may include having patients wrap the knee with a compressive dressing and apply ice for 20 minutes an hour several times a day to help control swelling and pain. Patients are advised to limit the time for placing ice on the extremity to minimize the risk of any type of skin problem such as frostbite. Most patients resume activities of daily living within a few days or weeks following surgery and taper off their pain medication. Reasons for slow rehabilitation, pain, and stiffness could include infection, painful effusion, low pain tolerance, a wrong diagnosis or, possibly, other, more obscure things, such as reflex sympathetic dystrophy, also known as complex regional pain syndrome.
Use of cold therapy machines for routine knee arthroscopy has scant scientific evidence documenting any therapeutic benefit in terms of controlling pain, swelling or leading to a quicker recovery. Typical applications for cold therapy machines in knee surgery include a major reconstruction procedure such as ligament reconstruction, knee replacement, revision knee surgeries, and arthrofibrosis. Many different machines are available, all with instructions for the prescribing physicians and staff to inform the patient of proper use, along with warning signs for problems associated with malfunction, and improper usage. When usage is indicated, generally the cold therapy units are for use only in the acute post-operative period, not for prolonged continuous use over several weeks. Continuous use of ice or cooling therapy machines has been associated with significant skin damage including varying degrees of frostbite, along with associated soft tissue compromise. Extra caution is advised by the manufacturer for patients with diabetes or underlying neurovascular diseases.
Cold therapy medical expert witness specialties include orthopaedic surgery, pediatric orthopaedic surgery, and pain medicine.