What is the evidence for cryotherapy after ACL reconstruction?

• A. No evidence
• B. Moderate evidence to reduce post-operative knee pain
• C. Strong evidence to accelerate healing
• D. Cryotherapy increases swelling

Answer: (B)

Cryotherapy after ACL reconstruction is most consistently supported for pain control in the immediate recovery period. Cooling the knee causes vasoconstriction and reduces nerve conduction and inflammatory activity, which translates to less pain and often reduced need for analgesics. Systematic reviews and trials have found moderate-quality evidence that patients experience lower pain scores with cryotherapy compared to usual care. There is some evidence that swelling may be reduced as well, but the findings are less consistent. Importantly, there isn’t strong evidence that cryotherapy speeds up graft healing, and when applied properly it does not increase swelling; risks come mainly from improper use (skin injury or frostbite). Therefore, the best-supported conclusion is that cryotherapy provides moderate evidence for reducing post-operative knee pain.