Knee Immobilization for Pain Control After a Hamstring Tendon Anterior Cruciate Ligament Reconstruction

• Published in: The American journal of sports medicine Vol. 37; no. 1; p. 56
• Main Authors: Hiemstra, Laurie A, Heard, S Mark, Sasyniuk, Treny M, Buchko, Greg L, Reed, Jeremy G, Monteleone, Bradley J
• Format: Journal Article
• Language: English
• Published: Baltimore American Orthopaedic Society for Sports Medicine 01-01-2009; Sage Publications Ltd
• Subjects: Analgesics; Knee; Ligaments; Pain; Patients; Skin & tissue grafts; Sports medicine; Surgery
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546508322896

Background This study will attempt to evaluate the efficacy of knee immobilization on patient pain levels after an anterior cruciate
ligament reconstruction.
Hypothesis There is no difference in visual analog scale pain scores 2 days after anterior cruciate ligament reconstruction between
patients who wear a knee immobilizer and those who do not wear a knee immobilizer.
Study Design Randomized clinical trial; Level of evidence, 1.
Methods Patients aged 18 to 40 years who met study inclusion criteria were eligible. Patients meeting intraoperative inclusion critiera
were randomized (immobilizer or no immobilizer) after wound closure. The immobilizer used was a soft, unhinged brace with
Velcro ® straps. Preoperative, intraoperative, and postoperative protocols were standardized. The primary outcome was patient self-assessed
pain using a 0-to-100-mm visual analog scale at day 2 after surgery. Secondary outcomes included pain and analgesic use in
the first 14 days after surgery, complications, and range of motion (approximately 3 weeks postoperatively). A sample size
estimate was calculated and resulted in the need for 44 patients per group.
Results A total of 102 patients were enrolled; 88 patients were randomized, and 14 were excluded intraoperatively. There was no difference
in mean visual analog scale pain scores at 2 days after surgery between immobilized and nonimmobilized patients (32.6 and
35.2, respectively; P = .59; difference, −2.6; 95% confidence interval, −12.2 to 6.9). There were no differences between groups in medication consumed,
range of motion, or complications. Pain and analgesic use were the same for both groups at 7 and 14 days postoperatively.
Conclusion No differences in pain or any of the secondary outcomes were detected between immobilized and nonimmobilized patients at
any point during the first 14 days after anterior cruciate ligament reconstruction.