The purpose of this study was to examine the effects of continuous passive motion (CPM) immediately following an arthroscopically assisted anterior cruciate ligament reconstruction (ACL) utilizing a bone patella bone (BPTB) autograft on the clinical signs of the inflammatory phase of soft tissue healing. The clinical signs that were examined are acute pain, swelling, and knee function. During the inflammatory phase, the study investigated the relationship between CPM and blood loss when utilizing a hemovac drain during the first post-operative 24 hours. Another purpose of this study was to determine the effects of CPM during the fibroplastic phase of soft tissue healing. During this phase, the relationship between CPM and swelling, and CPM and knee function was also investigated.
Thirty patients (15-45 yrs. old) participated in this study. The patients in this study were randomly placed into one of four groups. The first (chronic ACL) (n = 11) and second (acute ACL) (n = 4) groups used the CPM and began knee motion immediately following surgery. The third (chronic ACL (n = 9) and fourth (acute ACL) (n = 6) groups did not use the CPM following the surgery. All groups followed an identical post-operative rehabilitation program with the exception of the CPM groups using a CPM device. The design of this study included the collection of data during the inflammatory (1-3 days postsurgery) and fibroplastic phases (4-21 days postsurgery) of soft tissue healing.
The results indicated that the initiation of CPM immediately following an ACL reconstruction had a significant ($<$.05) effect on decreasing the amount of medication consumed by the patient, and a significant ($<$.05) decrease in the patient's need for medication during the inflammatory phase. There was no statistical significance in the level of perceived pain between the groups. Patients that received CPM had a significantly ($<$.01) greater decrease in joint ellusion and hemarthrosis during the inflammatory phase. The use of CPM during the fibroplastic phase resulted in a significant ($<$.025) decrease in hemarthrosis. There was no statistically significant difference in the amount of blood that was collected in the hemovac between groups. There was a statistically greater ($<$.05) increase in the degrees of active and passive knee flexion attained by patients that utilized CPM during the inflammatory and fibroplastic phases. No statistically significant difference was found between groups in the degrees of knee extension during these phases of soft tissue healing.
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McCarthy, M. R. (1990). The effects of immediate continuous passive motion on the clinical signs of soft tissue healing following an anterior cruciate ligament reconstruction. University of Virginia). ProQuest Dissertations and Theses, , 128-128 p.
Retrieved from http://search.proquest.com/docview/303900953?accountid=36196;
Burks, R., Daniel, D., & Losse, G. (1984).
This study was undertaken to examine the immediate effect of continuous passive motion (CPM) on anterior cruciate ligament (ACL) reconstruction stability. Ca daver knees were tested with a knee arthrometer with the anterior cruciate intact and then with the anterior cruciate sectioned. One of three anterior cruciate re constructions was then performed and stability was restored to the knee and it was again tested with the knee arthrometer. Stability was defined as being within 2 mm of the intact measurement. The three operations selected were the Marshall-Maclntosh "over-the-top," (OTT) a patellar bone-patellar tendon-tubercle bone (BTB) graft, and a semitendinosis reconstruction. The specimens were placed on a CPM device in a cooler at 38 degree F and put through a range of motion of 20 to 70 degree at 10 cycles per minute for 3 days. A success was less than a 2 mm increase in the post-CPM measurement compared to pre-CPM. All three bone-tendon-bone op erations failed. The semitendinosis operation was suc cessful in only three out of eight specimens. The OTT operation was successful in eight out of nine speci mens. The possible reasons for success and failure are discussed.Because of the potential problems with failure of an ACL with CPM it is suggested that the particular tech nique being used for an anterior cruciate reconstruction be tested prior to it being used with CPM clinically.
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The effect of continuous passive motion on anterior cruciate ligament reconstruction stability. American Journal of Sports Medicine, 12(4), 323-327. doi: http://dx.doi.org/10.1177/036354658401200414
Kirschner, P. P.
There is still a controversial discussion in literature about the use of motor driven splints in knee surgery--as the principle of continuous passive motion, CPM. For this reason it seemed useful for an evaluation to look through the papers which were published since 1990. It was obvious, that negative results were published often before this year, but this papers are still quoted standard works. In medical data bases subito-doc.de, medscape.com, medica.de and zbmed.de 230 papers were found by search CPM, continuous passive motion and arthromot. Coincidentally there was a search for authors who were already quoted in other papers. 36 papers concerning CPM after knee surgery were utilized. The role of CPM regarding the range of motion, swelling, duration of hospital stay, use of analgesics, costs, postoperative manipulations, wound healing and thrombo embolic complications was evaluated. Although the results of this partial retrospective, partial prospective, sometimes randomized or double blinded studies are in contradiction, there can only be found a trend to better results. New clinical studies for evidence based guidelines in the handling of continuous passive motion after knee surgery are necessary.
Βρείτε το πλήρες άρθρο:
Kirschner, P. P. (2004). [CPM--continuous passive motion: Treatment of injured or operated knee-joints using passive movement. A meta-analysis of current literature]. Der Unfallchirurg, 107(4), 328-340.
Retrieved from http://search.proquest.com/docview/71867567?accountid=36196;
Lenssen Ton AF, van Steyn, Mike JA, Crijns, Yvonne HF, Waltje Eddie MH, Roox, George M et al.
BMC Musculoskeletal Disorders
9 (2008): 60-60.
Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. Although research suggests that Continuous Passive Motion (CPM) should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered. Methods In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM) and functional recovery, measured at the end of the active treatment period, 17 days after surgery. Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days), followed by PT alone (usual care) in the first two weeks after hospital discharge. From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation) and regaining RoM in the knee. Results Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments. Conclusion Although results indicate that prolonged CPM use might have a small short-term effect on RoM, routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered, since neither long-term effects nor transfer to better functional performance was detected.
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"Lenssen, T. A. F., van Steyn, M.,J.A., Crijns, Y. H. F., Waltje, E. M. H., Roox, G. M., Geesink, R. J. T., . . . De Bie, R.,A. (2008). Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty. BMC Musculoskeletal Disorders, 9, 60-60. doi: http://dx.doi.org/10.1186/1471-2474-9-60 "
Mark J McElroy, Aaron J Johnson, Michael G Zywiel and Michael A Mont
Expert Rev. Med. Devices 8(1), 57–65 (2011)
Persistent pain and dysfunction following total knee arthroplasty require treatment beyond standard rehabilitation. This article discusses devices used to prevent and treat decreased range of motion. If deficits remain after initial standard therapy, multiple devices exist that can be used for nonoperative treatment. Load-control devices apply a constant force, producing variable soft-tissue displacement as tissues stretch. Static progressive stretch devices use the principle of stress relaxation by applying progressively increasing constant displacements. Both types of devices are reported to be effective in treating persistent knee stiffness. The authors feel that future developments will occur in improving treatment protocols for these devices.
..."Using CPM led to shorter hospital stays by a difference of approximately 1 day (95% CI: 0.03–1.35 days, based on 382 patients), improved active knee flexion at 2-week follow-up by a mean of 4.3° (95% CI: 2.0–6.6°, based on 286 patients) and lowered the incidence of postoperative manipulation by a relative risk of 0.12 (95% CI: 0.03–0.53, based on three trials). "...
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