Incidences of frostbite in arthroscopic knee surgery postoperative cryotherapy rehabilitation.

A retrospective study of 4 cases of frostbite was undertaken to examine causes and to identify related contributory behaviors and circumstances. These patients underwent various surgical interventions before the onset of frostbite during similar postoperative care regimens. Surgical procedures included some of the following in each patient: lateral retinacular release, vastus medialis oblique muscle advancement, partial medial meniscectomy, chondromalacia patella, trochlea, medial and lateral femoral condyle debridement, lateral retinaculum release, and excision of medial plica. The mechanism of onset, development, and sites of frostbite were uniform in all patients. In every case, the sites were located in the area on top of the patella including some adjacent regions depending on the size of each injury. Frostbite locations were correlated with the part of the cryotherapy cold cuff device located on top of the patellar region. This cuff portion was originally designed to accommodate surgical trauma induced during autogenous bone-tendon-bone graft harvest in anterior cruciate ligament reconstruction surgery. Locating cryotherapy over this region assisted in minimizing pain and effusion for patients subsequent to distal patella bone plug harvest trauma. However, the requirement for use of the pad in the patella area for patients not undergoing anterior cruciate ligament reconstruction with autograft was found to be unnecessary and was the primary cause of frostbite in the cases presented here.