Cryotherapy Device Research Articles

Bedside percutaneous cryoneurolysis technique for management of acute rib fracture pain in adult trauma patients

BackgroundAcute pain due to rib fractures causes significant in-hospital morbidity and impacts patients’ quality of life after discharge. Intraoperative transthoracic cryoneurolysis of the intercostal nerves can improve postoperative pain; however,...

Thermal Characterization and Preclinical Feasibility Verification of an Accessible, Carbon Dioxide-Based Cryotherapy System.

To investigate the potential of an affordable cryotherapy device for the accessible treatment of breast cancer, the performance of a novel carbon dioxide-based device was evaluated through both benchtop testing and an in vivo canine model. This novel device was quantitatively compared to a commercial device that utilizes argon gas as the cryogen. The thermal behavior of each device was characterized through calorimetry and by measuring the temperature profiles of iceballs generated in tissue phantoms. A 45 min treatment in a tissue phantom from the carbon dioxide device produced a 1.67 ± 0.06 cm diameter lethal isotherm that was equivalent to a 7 min treatment from the commercial argon-based device, which produced a 1.53 ± 0.15 cm diameter lethal isotherm. An in vivo treatment was performed with the carbon dioxide-based device in one spontaneously occurring canine mammary mass with two standard 10 min freezes. Following cryotherapy, this mass was surgically resected and analyzed for necrosis margins via histopathology. The histopathology margin of necrosis from the in vivo treatment with the carbon dioxide device at 14 days post-cryoablation was 1.57 cm. While carbon dioxide gas has historically been considered an impractical cryogen due to its low working pressure and high boiling point, this study shows that carbon dioxide-based cryotherapy may be equivalent to conventional argon-based cryotherapy in size of the ablation zone in a standard treatment time. The feasibility of the carbon dioxide device demonstrated in this study is an important step towards bringing accessible breast cancer treatment to women in low-resource settings.

The CryoPop study: Screening for high-grade cervical dysplasia in Karnataka, India.

To describe our experience of screening with visual inspection with acetic acid (VIA) and colposcopy to identify women with high-grade precancerous cervical lesions who were candidates for cryotherapy. Women were screened to determine eligibility for a clinical trial testing the safety and efficacy of a new, simple and inexpensive cryotherapy device (CryoPop®) targeted for use in low and middle-income countries (LMICs). Prospective cohort study. Primary and urban health centres in Belagavi, Hubballi and Vijayapur, India. Women in the age-group 30-49 years, premenopausal, with no prior hysterectomy and no known HIV infection were eligible for screening. Visual inspection with acetic acid was performed on eligible women following informed consent. VIA-positive women were referred for colposcopy and biopsy. Biopsies were read by two pathologists independently, with a third pathologist acting as tie-breaker if needed. The primary outcome measures were the number/proportion of women screening positive by VIA and the number/proportion of those women screening VIA-positive found to have high-grade cervical lesions on biopsy (cervical intraepithelial neoplasia 2/3 [CIN 2/3]). Demographic variables were compared between women who screened VIA-positive and those who screened VIA-negative; a separate comparison of demographic and limited reproductive variables was performed between women who had CIN 2/3 on biopsy and those without CIN 2/3 on biopsy. Chi-square or Fisher's exact tests for categorical data and t-tests or analysis of variance for numeric data were used with all tests two-sided and performed at an alpha 0.05 level of statistical significance. A total of 9130 women were screened with VIA between 4 July 2020 and 31 March 2021. The mean age of all women screened was 37 years (standard deviation = 5.6 years) with 6073 of the women (66.5%) in the 30-39 year range. Only 1% of women reported prior cervical cancer screening. A total of 501 women (5.5%) were VIA-positive; of these, 401 women underwent colposcopy. Of those who had colposcopy, 17 (4.2%) had high-grade lesions on biopsy, an additional 164 (40.9%) had low-grade cervical lesions on biopsy or endocervical curettage and one woman (0.2%) was found to have invasive cancer. VIA-positive women were younger and had higher levels of education and income; however, women who were VIA-positive and found to have CIN 2/3 were older, were more likely to be housewives and had higher household income than those without CIN 2/3. Despite the COVID-19 pandemic, over 9100 women were screened with VIA for precancerous lesions. However, only 17 (4.2%) were found to have biopsy-proven high-grade cervical lesions, underscoring the subjective performance of VIA as a screening method. Given that this is significantly lower than rates reported in the literature, it is possible that the prevalence of high-grade lesions in this population was impacted by screening a younger and more rural population. This study demonstrates that screening is feasible in an organised fashion and can be scaled up rapidly. However, while inexpensive and allowing for same-day treatment, VIA may be too subjective and have insufficient accuracy clearly to identify lesions requiring treatment, particularly in low-prevalence and low-risk populations, calling into question its overall cost-effectiveness.

Continuous cryotherapy vs. traditional cryotherapy after total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials.

Cryotherapy is widely applied to relieve pain and improve functional outcomes after total knee arthroplasty (TKA). New cryotherapy devices have recently been developed to guarantee a fixed temperature for a prolonged time. Therefore, we conducted a systematic review and meta-analysis to compare continuous cryotherapy and traditional cryotherapy (ice bag or gel pack) for patients after TKA. This study was conducted according to a predefined protocol registered on PROSPERO. Two independent reviewers performed an electronic database search of PubMed, Embase, Cochrane, Web of Science, Google Scholar, and ClinicalTrials.gov. Dichotomous outcomes were reported as risk difference (RD) with 95% confidence intervals (CIs), and continuous outcomes were reported as mean difference (MD), or standardized mean difference (SMD) with 95% CIs. Seven trials enrolling a total of 519 patients were included. There were no differences in pain intensity (MD: -0.54, 95% CI: -1.55 to 0.47; P = 0.30), analgesics consumption (MD: -0.37, 95% CI: -1.28 to 0.55; P = 0.43), postoperative range of motion (MD: 0.47, 95% CI: -4.09 to 5.03; P = 0.84), swelling of the knee joint, blood loss, change in hemoglobin, or transfusion rate. Meanwhile, there were no differences in length of hospital stay (MD: -0.77, 95% CI: -1.62 to 0.08; P = 0.07) and adverse events (RD: 0, 95% CI: -0.02 to 0.03; P = 0.74). In addition, continuous cryotherapy leads to extra costs and resources than traditional cryotherapy. Continuous cryotherapy does not appear to offer significant benefits for TKA when compared with traditional cryotherapy. Based on currently available evidence, traditional cryotherapy is still recommended as continuous cryotherapy is not cost-effective. Further well-designed studies with larger sample sizes are warranted to further confirm these preliminary results. PROSPERO Registration: Identifier [CRD42022308217].

Development of cryotherapy device using refrigerant compressor for decreased skin temperature

Cryotherapy is a commonly used technique in sports medicine and physical therapy for the treatment of acute injuries and pain management. The application of cold temperatures leads to a decrease in skin surface temperature, which can have several physiological effects on the body. This can help to reduce inflammation, swelling, and pain in the affected area. Cryotherapy can be administered using various modalities, but controlled continuous cold devices are widely used in cryotherapy treatment due to their accurate temperature control, especially when treating large joints. These devices work by pumping cold water alternately into a cooling pad that is wrapped around a patient's limbs. The aim of this study is to develop a cryotherapy device that regulates low skin temperature for effective physical therapy treatment. This will be achieved by utilizing a refrigerant compressor in combination with a remote source of chilled water that is circulated through a cooling pad placed on the treatment site. The results show that this device can control temperature from 20oC to 5oC with a fluctuation of ± 0.4oC at the cooling pad. A test study on 32 volunteers showed that the skin temperature in the knee area can drop to 15.1oC±1.7oC (95% CI, 18.6-11.1oC) after 30 minutes of applying a cooling pad at 10oC. The experimental cryotherapy results on the skin surface are consistent with the simulation test results, indicating that this device can be developed into a medical device that provides precise and continuous temperature control, thereby ensuring ease of use and maximum therapeutic benefit in the field of physical therapy.

Effect of a Temperature-Adjustable Cryotherapy Device on Mice with Lysophosphatidic Acid-Induced Pruritus.

Effect of a Temperature-Adjustable Cryotherapy Device on Mice with Lysophosphatidic Acid-Induced Pruritus.

Effect of a Precision Cryotherapy Device with Temperature-Adjustability on Mice with Cutibacterium acnes-Induced Inflammation.

Effect of a Precision Cryotherapy Device with Temperature-Adjustability on Mice with Cutibacterium acnes-Induced Inflammation.

Revisiting the Role of Local Cryotherapy for Acne Treatment: A Review and Update

Acne vulgaris is a well-recognized condition among adolescents and adults that adversely affects their quality of life. Local cryotherapy has long been reported to be effective in treating acne vulgaris, inducing a more rapid involution of acne than topical medications. However, the use of cryotherapy has been limited for acne treatment due to several drawbacks, including procedural pain and pigmentary alterations. Currently, newer cryotherapy devices are gaining attention in dermatology due to their ability to monitor and precisely control the target temperature. In this narrative review, a brief history and the latest update on acne cryotherapy will be presented. Additionally, a special emphasis is placed on the role of cryotherapy, alone or in combination with intralesional steroid injections for nodulocystic acne.

The Role of Cryotherapy After Total Knee Arthroplasty: A Systematic Review

BackgroundPrevious research shows conflicting evidence regarding the postoperative role of cryotherapy after total knee arthroplasty (TKA). This systematic review aims to further investigate the effect of various methods of cryotherapy on the following: (1) pain; (2) swelling; (3) postoperative opioid use; and (4) range of motion (ROM). MethodsA strategic keyword search of Medline, Cochrane, Embase, and CINAHL retrieved randomized controlled trials examining cryotherapy following TKA published between February 1, 2017, and February 24, 2022. The studied outcomes included pain ratings, knee/limb swelling, opioid use, and ROM. Six studies were selected for inclusion in this review. ResultsOpioid use was significantly decreased in cryotherapy groups compared to noncryotherapy groups within the first postoperative week only (P < .05). This effect may be augmented by the use of computer-assisted (temperature regulated) cryotherapy devices, compared to other modalities including ice packs. Pain ratings also decrease, but this decrease may not be clinically relevant. Cryotherapy appears to confer no consistent benefit to ROM and swelling at any time point. Computer-assisted cryotherapy may be associated with decreased opioid consumption after TKA compared to traditional ice packs. ConclusionCryotherapy’s role after TKA appears to be in decreasing opioid consumption primarily in the first postoperative week. Pain ratings also decrease consistently with cryotherapy use, but this decrease may not be clinically relevant. Study heterogeneity requires further research focusing on optimizing cryotherapy modalities within the first postoperative week, and analyzing cost associated with modern outpatient postoperative TKA protocols.

8580 Comparison of Anesthetic Usage with Different Endometrial Ablation Devices

<h3>Study Objective</h3> To compare the anesthetic requirements associated with the use of different non-resectoscopic endometrial ablation (NREA) techniques. <h3>Design</h3> Retrospective comparative analysis for five marketed NREA devices using the information reported in their FDA approved instructions for use (IFU). "Physician discretion" directed anesthesia data were compared. <h3>Setting</h3> Office and operating room. <h3>Patients or Participants</h3> The Intent to treat population reported in IFU for the clinical studies conducted in support of FDA Premarket approval of five endometrial ablation devices. <h3>Interventions</h3> Endometrial ablation with the Cerene® Cryotherapy Device, Genesys® HTA Endometrial Ablation System, Mara™ Water Vapor Ablation System, Minerva® Endometrial Ablation System, and NovaSure® Impedance Controlled Endometrial Ablation System. <h3>Conclusion</h3> When comparing endometrial ablation modalities, anesthetic requirements should factor into choosing one technique over another, especially when considering an in-office procedure. Based on these data, cryoablation with Cerene was significantly more likely to be performed without IV medications (97%) demonstrating high tolerability for office use, as compared with hyperthermic endometrial ablation devices.

Efficacy of a new cryotherapy device on pain relief during the laser tattoo removal

Efficacy of a new cryotherapy device on pain relief during the laser tattoo removal

Cost-utility study of home-based cryotherapy device for wart treatment: a randomized, controlled, and investigator-blinded trial

Background Cryotherapy is typically performed by physicians. No cost-utility studies of home-based cryotherapy have been reported. Objectives To study the cost utility of home-based cryotherapy devices and in-hospital liquid nitrogen therapy for cutaneous warts. Materials and methods This randomized, controlled, investigator-blinded trial was carried out on patients with cutaneous warts. Participants were randomly assigned to two groups: home-based cryotherapy and in-hospital liquid nitrogen therapy. Clinical examinations were conducted at baseline and monthly until cure, and outcomes (cure rate, side effects, total costs, and quality of life) were compared. A cost-utility analysis was performed. Results Nineteen of 22 patients completed the treatment and were analyzed. The efficacy of home-based cryotherapy and in-hospital therapy was 72.8% and 64.3%, respectively. Side effects (pain, redness, and burning) were observed. The mean numbers of medical visits were 2.83 for home-based therapy and 3.30 for in-hospital therapy. The total costs for home-based therapy and the in-hospital therapy were US $76.03 and $100.45, respectively. The home-based therapy had 0.2297 quality-adjusted life years, slightly higher than the corresponding value of 0.2254 for in-hospital therapy. Conclusions Home-based cryotherapy devices are a cost-saving strategy with similar efficacy to in-hospital liquid nitrogen therapy.

Endometrial Cryoablation for the Treatment of Heavy Menstrual Bleeding: 36-Month Outcomes from the CLARITY Study.

Study ObjectiveTo examine long-term outcomes from the pivotal study that evaluated the safety and effectiveness of the Cerene® Cryotherapy Device (Channel Medsystems, Berkeley, CA) in premenopausal women with heavy menstrual bleeding due to benign causes who have completed childbearing.MethodsThe prospective, multicenter, single-arm, open-label study had eight sites in the USA, one in Mexico, and two in Canada. Inclusion criteria included uterine sound ≤10 cm, endometrial cavity length 2.5 to 6.5 cm, age 25 to 50 years, a pictorial blood loss assessment chart score of ≥150, no submucosal myomata and/or uterine obstruction, distortion, or abnormality. A total of 242 subjects underwent a 2.5-minute cryoablation. Long-term follow-up visits were conducted at Month 24 and Month 36. Data collected included gynecological adverse events, description of last menstrual period, contraception status, self-report of pregnancy, medical or surgical interventions to treat abnormal uterine bleeding, satisfaction, recommendation, and quality of life (QoL). QoL outcomes were measured with the Menorrhagia Impact Questionnaire (MIQ) and the Premenstrual Symptoms Impact Survey (PMSIS™).Results201 subjects completed their Month 36 final study visit. Subject outcomes were comparable to those at Month 12. Eighty-nine percent of subjects reported amenorrhea, a lighter-than-normal, or normal period, 91% of subjects had no or slight limitations in MIQ measured activities, and 85% reported premenstrual symptoms at a low frequency. Eighty-five percent of the subjects were satisfied or very satisfied. The cumulative incidence of hysterectomy was 5% and reintervention was 8.7%. Forty-nine gynecologic adverse events (AE) were reported; one non-serious AE, postcoital bleeding, was reported as related to the procedure. No serious device-related or procedure-related AEs were reported.ConclusionStudy data demonstrate that the positive effects of Cerene Cryotherapy Device treatment are sustained through Month 36 and that the risks associated with the device and procedure are low (ClinicalTrials.gov; NCT02842736).

Effect of a Precision Cryotherapy Device with Temperature Adjustability on Pigmentation.

Background:Pigmentary skin disorders impair the quality of life, leading to the development of therapeutic modalities. However, these treatments should focus more on effectiveness and safety.Aims and Objectives:To evaluate the effect of a temperature-adjustable cryotherapy device on the expression of pigmentation-related biomarkers.Methods and Results:A temperature- and time-adjustable cryotherapy device was employed to improve 200 mJ UVB-induced pigmentation on mice at −5°C (for 5, 10 or 20 s), 0°C (for 5, 10 or 20 s), 5°C (for 5, 10 or 20 s), or 10°C (for 5, 10 or 20 s). Expression of pigmentation-related biomarkers, such as tyrosinase, c-kit, melanocortin 1 receptor and microphthalmia-associated transcription factor before and after treatment with the cryotherapy device was investigated with real-time polymerase chain reaction and immunohistochemistry.Results:Expression of pigmentation-related biomarkers was decreased after the treatment of the temperature-adjustable cryotherapy device. Gene expression of the pigmentation-related biomarkers was decreased under the above conditions with some exception. Protein expression of the pigmentation-related biomarkers showed decreased tendency under the conditions with some exceptions.Conclusion:The temperature-adjustable cryotherapy device used in this study reduced the expression of pigmentation-related biomarkers on mice and may be used to treat patients with skin pigmentation.

Modern management of acute non-variceal upper gastrointestinal bleeding

Acute, non-varicose bleeding from the upper gastrointestinal tract remains a common clinical problem. Bleeding episodes are associated with high mortality and a significant economic burden on the health care system. Despite the continuing improvement in endoscopic treatment, recurrent bleeding and associated mortality are still a pressing issue. In addition to the well-established modalities of endoscopic hemostasis: injection, thermal, mechanical, used both as mono therapy and as part of a combination therapy, the review discusses the use of novel types of endoscopic devices. The results of the use of over-the-scope clips, coagrasper, hemostatic sprays, endoscopic angiography, radiofrequency ablation, cryotherapy and endoscopic suturing device are described. The technical aspects of their application, the issues of efficacy and safety, the advantages and limitations of methods for achieving final endoscopic hemostasis are considered. The methods of initial assessment and treatment strategies for recurrent bleeding and unsuccessful endoscopic hemostasis were also analyzed. Material and methods. Literature search was carried out using the following electronic information resources: CyberLeninka, PubMed, Nature Pathology, MEDLINE, PLoS ONE. Results. Сombined endoscopic hemostasis is a standard therapy in the treatment of gastrointestinal tract cerebral infections with an efficiency of 95-98 %, new modalities of endoscopic hemostasis are able, in some cases, to achieve final endoscopic hemostasis both in primary endoscopic treatment and in recurrent bleeding.

Safety and efficacy of the new CryoPop\xae cryotherapy device for cervical dysplasia in low- and middle-income countries: study protocol for a multicenter open-label non-inferiority clinical trial with historical controls

BackgroundCervical cancer is the fourth most common cancer in the world, affecting mainly women residing in low- and middle-income countries. Progression from a pre-invasive phase to that of an invasive phase generally takes years and provides a window of opportunity to screen for and treat precancerous lesions.MethodsThis study is being conducted at four sites in north Karnataka, India. Community sensitization activities have been organized in the study areas to create awareness among stakeholders, including elected representatives, physicians, health care workers, and potential participants. Organized community based as well as hospital-based screening is being conducted using visual inspection with acetic acid (VIA). Screen positive women are referred to respective study hospitals for colposcopy and directed biopsy. Participants with confirmed high-grade cervical dysplasia (high-grade squamous intraepithelial lesions or HSIL) who fit all other eligibility criteria will be recruited to the study and will receive cryotherapy using CryoPop®, an innovative new cryotherapy device.DiscussionThere is a need to develop an inexpensive, simple, and effective cryotherapy device for use by frontline health care providers at locations where screening and timely treatment can be given, accelerating access to cervical cancer prevention services and minimizing loss to follow-up of women with precancerous lesions who need treatment.Trial registrationClinical Trial Registry - India CTRI/2019/01/017289 ClinicalTrials.Gov number NCT04154644. Registered on November 6, 2019.

Hysteroscopic Access and Uterine Cavity Evaluation 12 Months after Endometrial Ablation with the Cerene Cryotherapy Device

To evaluate whether physical access and the ability to systematically assess the postablation uterine cavity were preserved at 12 months after endometrial ablation with the Cerene cryotherapy device (ChannelMedsystems, Emeryville, CA). A prospective, multicenter, single-arm study. In the clinic at 8 US sites and outpatient hospital setting at 2 sites in Canada and 1 site in Mexico. A total of 230 (of 242) subjects continued in the study at the Month 12 visit after ablation. Two hundred twenty-three subjects were available for a diagnostic hysteroscopic evaluation. Subjects who had previously been treated with a 2.5-minute cryoablation of the endometrium utilizing the Cerene device underwent a diagnostic hysteroscopy at the Month 12 follow-up visit. The uterine cavity was accessible in 220 of 223 subjects (98.7%) and not accessible in 3 (1.3%) because of pain (n=2) and cervical stenosis (n=1). Visualization of the uterine cavity was possible in 204 of 220 subjects (92.7%) with one or both tubal ostia identified in 89.2% (182 of 204) of subjects. Both tubal ostia were visible in 160 of 204 subjects (78.4%) and one ostium in 22 of 204 subjects (10.8%). The cavity was not visualized in the remaining 16 of 220 subjects (7.2%) because of intrauterine adhesions (n=14), technical difficulties (n=1), or menstruation (n=1). In 95.6% (195 of 204) of subjects where the cavity was visualized, the hysteroscopic view was judged adequate to evaluate the uterine cavity for pathologic change. No significant complications occurred during the hysteroscopic evaluations. This is the largest study to date conducted to hysteroscopically evaluate the postablation uterine cavity. Uterine cavity assessment with in-office hysteroscopy 1 year after the use of the Cerene cryotherapy device is attainable, enabling both diagnostic and therapeutic procedures within the endometrial cavity.

The Cerene Cryoablation Device for the Treatment of Heavy Menstrual Bleeding: 36-Month Outcomes from the Clarity Study

<h3>Study Objective</h3> To evaluate the safety and effectiveness of a novel cryoablation device (<i>Cerene Cryotherapy Device, Channel Medsystems, Berkeley, CA)</i> in premenopausal women with heavy menstrual bleeding (HMB) due to benign causes. <h3>Design</h3> A prospective, multi-center, single-arm, open-label study. <h3>Setting</h3> 8 sites in the USA, 1 in Mexico, 2 in Canada. <h3>Patients or Participants</h3> 242 Intent-to-Treat women, 25 to 50 years of age, with HMB, uterine sound ≤10 cm, and endometrial cavity between 2.5 to 6.5 cm. <h3>Interventions</h3> The Cerene single-use disposable device, delivered a 2.5-minute cryoablation of the endometrium. Analgesia and local anesthesia were administered per investigator discretion: 97% of subjects received a paracervical block with or without oral medications, 3% IV sedation, and none received general anesthesia. 180 USA treatments were performed in the physician office setting and none in the operating room. Subjects were evaluated through Month 12 and long term at Month 24 and 36. <h3>Measurements and Main Results</h3> 201 women were evaluated at Month 36. 88.6% (178/201) reported amenorrhea, a lighter than normal, or normal period. 91% (182/201) reported no or slight limitations in life activities in their Menorrhagia Impact Quality of Life (QoL) questionnaire. 85% (171/201) reported premenstrual symptoms (PMS) at a low frequency (none, rarely, or sometimes) in their PMS Impact QoL Survey. 84.5% (153/181) of subjects who reported level of satisfaction at the final study visit stated that they were satisfied or very satisfied with their treatment outcome. 7% (17/242) underwent a post ablation intervention for menstrual bleeding. <h3>Conclusion</h3> The Cerene endometrial cryoablation device maintains safety and effectiveness for the treatment of HMB through the long-term study visit at 36 months. It is a global endometrial ablation technique that can be performed consistently in the office setting requiring minimal anesthesia or analgesia.

HOW MANY PAIN PILLS DO WE PRESCRIBE: A SURVEY OF PARTICIPANTS IN SCORE: A QUALITY IMPROVEMENT INITIATIVE (204)

Objectives:The public health opioid abuse epidemic has led to nationwide interest in judicious use and close monitoring of opioid pain medication. Knee arthroscopy(KA) and anterior cruciate ligament reconstruction(ACLR) are common procedures in adolescent patients for which narcotics have been historically utilized for post-operative pain management. The purpose of this study is to investigate pain management strategies following basic KA or ACLR by pediatric sports surgeons who contribute to a multi-center quality improvement initiative(SCORE).Methods:Surgeon participants in SCORE represent fifteen U.S. institutions from primarily academic teaching hospitals who specialize in pediatric sports medicine. Surgeons contribute all ACLR and other KA-related cases. A RedCap survey was distributed to all SCORE surgeon participants in December 2019. A KA (defined as a knee arthroscopy that does not include a ligament reconstruction or a cartilage procedure other than chondroplasty) represented a less invasive procedure, while the ACLR represented a more invasive procedure. Survey results were collected and analyzed for both practice patterns of regional anesthesia utilization and post-operative narcotic prescribing volumes.Results:Twenty-eight SCORE surgeon participants completed the survey, a 100% response rate. A planned prescription of a mean of 16.4 pain pills (range 0-40 pills) were reported for pain management following a KA, only 32.1% of surgeons reported adjunctive regional anesthesia techniques for this procedure in addition to general anesthesia. Following an ACLR, surgeons reported a planned prescription of a mean 23.8 pain pills (range 0-40 pills) and most (92.3%) reported utilization of regional anesthesia for their peri-operative analgesia strategy. Of those using adjunctive regional anesthesia, significant variability was reported: 30.7% reported indwelling catheter placement for peripheral nerve block following ACLR as opposed to a single shot injection method, and several block locations were reported to be utilized of which adductor canal (67.9%) block was the most common (see Figure 1). For both procedure types, variability in multi-modal pain management was noted, with incomplete adoption of the use of additional non-narcotic medication (acetaminophen, 64.2%; and NSAIDS, 75%). Cryotherapy devices were applied/prescribed in 75.0% of knee arthroscopy procedures and 92.8% of ACLR.Conclusions:Despite evidence for effective adjunctive pain management strategies, incomplete adoption of multi-modal techniques and reliance on narcotic medication remains a significant component of pediatric sports surgical practice; with on average > 15 pills prescribed following these procedures. Opportunities for reducing practice variability, adoption of multi-modal analgesia strategies, and decreasing post-operative narcotic use following common adolescent knee procedures exist for this subset of pediatric sports medicine specialists

Early postoperative practices following anterior cruciate ligament reconstruction in France

IntroductionThe early postoperative period after anterior cruciate ligament reconstruction (ACL) is critical for optimal functional recovery. Despite an abundance of literature, there is no consensus regarding good practices. This period is often under-considered by orthopedic surgeons. The aim of this study was to identify early postoperative practices after ACL reconstruction in France. HypothesisThe hypothesis was that there was a discrepancy between validated data in the literature and the current practices of orthopedic surgeons in France. Material and methodsIn 2019, a questionnaire was sent to all the members of the French Arthroscopy Society to investigate their postoperative practices after ACL reconstruction. Two hundred sixty-nine members responded. Surgeons were divided into two groups of experienced (n=137) and less experienced (n=132) surgeons, according to the number of ACL reconstructions performed per year (<or≥50/year). Outpatient management, effusion prevention measures, and rehabilitation instructions and goals were collected. Overall responses were analyzed after multiple linear logistic regression and the responses of the two groups were compared. ResultsACL reconstruction was performed as an outpatient procedure in 72.9% of cases. This rate increased with surgical experience (p=0.009×10−3). Among measures to prevent effusion, cryotherapy was recommended in 97.8% of cases. The experienced group more often used compressive cryotherapy devices (p=0.004). Rehabilitation was started immediately in 75.5% of cases, with as main objective recovery of full extension (89.6%). Weight-bearing was allowed in 98.5% of cases and a brace was prescribed in 69.9% of cases. In the experienced group, braces were less frequent (p=0.02) and self-rehabilitation was preferred (p=0.0006). ConclusionEarly postoperative practices after ACL reconstruction in France are related to surgical experience. The greater the surgical experience, the greater the role of joint effusion prevention and self-rehabilitation. Despite recommendations in the literature, a quarter of the French orthopedic surgeons who responded to this survey did not perform this procedure on an outpatient basis and more than two-thirds prescribed braces. Level of EvidenceIV.