Effectiveness of cryotherapy in reducing swelling, pain, blood loss and improving range of motion in Effectiveness of cryotherapy in reducing swelling, pain and blood loss, and improving range of motion during the early phase of rehabilitation after anterior cruciate ligament reconstruction: A systematic review

Cryotherapy is a commonly used physiotherapeutic modality in rehabilitation following anterior cruciate ligament reconstruction (ACLR). Previous systematic reviews (published in 2005 and 2014) concluded that the available evidence was insufficient to determine its effectiveness in postoperative recovery. This systematic review aimed to update and synthesize current evidence on cryotherapy after ACLR, including all randomized controlled trials (RCTs) investigating any form of postoperative cryotherapy (e.g., ice packs, continuous-flow devices, and compression-cooling devices). A comprehensive search of MEDLINE (PubMed), Embase, Web of Science, PEDro (Physiotherapy Evidence Database), and PROSPERO was conducted in April 2024 and updated in October 2025. Eligible studies included RCTs involving adults (≥18 years) undergoing ACLR. A total of 273 RCTs were identified, of which 9 studies (n = 509 participants) met the inclusion criteria. Outcomes included pain, range of motion (ROM), postoperative blood loss, and functional measures. Cryotherapy showed potential benefits in reducing pain and improving ROM in the early postoperative phase. However, results were inconsistent across studies, with substantial heterogeneity in intervention protocols, outcome measures, and follow-up time points. Overall, the current evidence remains limited and methodologically heterogeneous, with no clear consensus regarding the effectiveness of cryotherapy after ACLR. Further high-quality, standardized RCTs are needed to clarify its clinical value and determine which cryotherapy modalities may be most effective.