The efficacy of continuous passive motion after anterior cruciate ligament reconstruction: A systematic review

The application of continuous passive motion (CPM) following anterior cruciate ligament (ACL) is viewed with controversy by both orthopaedic surgeons and physiotherapists. The objective of this review was to assess the efficacy of CPM following ACL reconstruction. An electronic search was performed using the electronic databases AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, ovid Medline, Physiotherapy Evidence Database (PEDro) and Pubmed. All English language, human subject, clinical trials, comparing the effects of CPM against a non-CPM group following ACL reconstruction were reviewed. The methodological quality of the literature was assessed independently by two reviewers using the PEDro scoring system. Eight papers including 505 ACL reconstructions were reviewed. The findings of this review suggested that it was unclear whether the application of CPM post-operatively has any benefit for ACL reconstruction patients. Furthermore, there were numerous methodological weaknesses within the evidence-base. In the absence of strong evidence, the continued use of CPM cannot be supported. Further study is recommended to improve the evidence-base, assess different CPM protocols, evaluate the efficacy of CPM following hamstring tendon grafts, and to assess functional outcomes and quality of life in patients who have and have not received CPM following an ACL reconstruction.