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Study flow diagram. Results from the 2003 version of this systematic review are included in the 2009 search results because a full search was re‐done in 2009 using a new search strategy.
Figuras y tablas -
Figure 1

Study flow diagram. Results from the 2003 version of this systematic review are included in the 2009 search results because a full search was re‐done in 2009 using a new search strategy.

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Methodological quality summary: review authors' judgements about each methodological quality item for each included trial.
Figuras y tablas -
Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included trial.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Comparison 1 Main comparison, Outcome 1 Active knee flexion ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 1.1

Comparison 1 Main comparison, Outcome 1 Active knee flexion ROM ‐ short‐term effects.

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Comparison 1 Main comparison, Outcome 2 Active knee flexion ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.2

Comparison 1 Main comparison, Outcome 2 Active knee flexion ROM ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 3 Active knee flexion ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 1.3

Comparison 1 Main comparison, Outcome 3 Active knee flexion ROM ‐ long‐term effects.

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Comparison 1 Main comparison, Outcome 4 Pain ‐ short‐term effects.
Figuras y tablas -
Analysis 1.4

Comparison 1 Main comparison, Outcome 4 Pain ‐ short‐term effects.

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Comparison 1 Main comparison, Outcome 5 Pain ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.5

Comparison 1 Main comparison, Outcome 5 Pain ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 6 Pain ‐ long‐term effects.
Figuras y tablas -
Analysis 1.6

Comparison 1 Main comparison, Outcome 6 Pain ‐ long‐term effects.

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Comparison 1 Main comparison, Outcome 7 Function ‐ short‐term effects [standardised mean].
Figuras y tablas -
Analysis 1.7

Comparison 1 Main comparison, Outcome 7 Function ‐ short‐term effects [standardised mean].

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Comparison 1 Main comparison, Outcome 8 Function ‐ medium‐term effects [standardised mean].
Figuras y tablas -
Analysis 1.8

Comparison 1 Main comparison, Outcome 8 Function ‐ medium‐term effects [standardised mean].

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Comparison 1 Main comparison, Outcome 9 Function ‐ long‐term effects [standardised mean].
Figuras y tablas -
Analysis 1.9

Comparison 1 Main comparison, Outcome 9 Function ‐ long‐term effects [standardised mean].

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Comparison 1 Main comparison, Outcome 10 Quality of life ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.10

Comparison 1 Main comparison, Outcome 10 Quality of life ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 11 Quality of life ‐ long‐term effects.
Figuras y tablas -
Analysis 1.11

Comparison 1 Main comparison, Outcome 11 Quality of life ‐ long‐term effects.

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Comparison 1 Main comparison, Outcome 12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points].
Figuras y tablas -
Analysis 1.12

Comparison 1 Main comparison, Outcome 12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points].

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Comparison 1 Main comparison, Outcome 13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.13

Comparison 1 Main comparison, Outcome 13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 14 Manipulation under anaesthesia [number].
Figuras y tablas -
Analysis 1.14

Comparison 1 Main comparison, Outcome 14 Manipulation under anaesthesia [number].

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Comparison 1 Main comparison, Outcome 15 Adverse events [number].
Figuras y tablas -
Analysis 1.15

Comparison 1 Main comparison, Outcome 15 Adverse events [number].

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Comparison 1 Main comparison, Outcome 16 Passive knee flexion ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 1.16

Comparison 1 Main comparison, Outcome 16 Passive knee flexion ROM ‐ short‐term effects.

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Comparison 1 Main comparison, Outcome 17 Passive knee flexion ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.17

Comparison 1 Main comparison, Outcome 17 Passive knee flexion ROM ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 18 Passive knee flexion ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 1.18

Comparison 1 Main comparison, Outcome 18 Passive knee flexion ROM ‐ long‐term effects.

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Comparison 1 Main comparison, Outcome 19 Active knee extension ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 1.19

Comparison 1 Main comparison, Outcome 19 Active knee extension ROM ‐ short‐term effects.

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Comparison 1 Main comparison, Outcome 20 Active knee extension ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.20

Comparison 1 Main comparison, Outcome 20 Active knee extension ROM ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 21 Active knee extension ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 1.21

Comparison 1 Main comparison, Outcome 21 Active knee extension ROM ‐ long‐term effects.

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Comparison 1 Main comparison, Outcome 22 Passive knee extension ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 1.22

Comparison 1 Main comparison, Outcome 22 Passive knee extension ROM ‐ short‐term effects.

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Comparison 1 Main comparison, Outcome 23 Passive knee extension ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.23

Comparison 1 Main comparison, Outcome 23 Passive knee extension ROM ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 24 Passive knee extension ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 1.24

Comparison 1 Main comparison, Outcome 24 Passive knee extension ROM ‐ long‐term effects.

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Comparison 1 Main comparison, Outcome 25 Length of hospital stay.
Figuras y tablas -
Analysis 1.25

Comparison 1 Main comparison, Outcome 25 Length of hospital stay.

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Comparison 1 Main comparison, Outcome 26 Swelling ‐ short‐term effects.
Figuras y tablas -
Analysis 1.26

Comparison 1 Main comparison, Outcome 26 Swelling ‐ short‐term effects.

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Comparison 1 Main comparison, Outcome 27 Swelling ‐ medium‐term effects.
Figuras y tablas -
Analysis 1.27

Comparison 1 Main comparison, Outcome 27 Swelling ‐ medium‐term effects.

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Comparison 1 Main comparison, Outcome 28 Quadriceps strength ‐ short‐term effects [standardised mean].
Figuras y tablas -
Analysis 1.28

Comparison 1 Main comparison, Outcome 28 Quadriceps strength ‐ short‐term effects [standardised mean].

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 1 Active knee flexion ROM.
Figuras y tablas -
Analysis 2.1

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 1 Active knee flexion ROM.

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 2 Passive knee flexion ROM.
Figuras y tablas -
Analysis 2.2

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 2 Passive knee flexion ROM.

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 3 Active knee extension ROM.
Figuras y tablas -
Analysis 2.3

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 3 Active knee extension ROM.

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 4 Passive knee extension ROM.
Figuras y tablas -
Analysis 2.4

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 4 Passive knee extension ROM.

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 5 Length of hospital stay.
Figuras y tablas -
Analysis 2.5

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 5 Length of hospital stay.

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 6 Function.
Figuras y tablas -
Analysis 2.6

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 6 Function.

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 7 Pain.
Figuras y tablas -
Analysis 2.7

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 7 Pain.

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Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 8 Swelling.
Figuras y tablas -
Analysis 2.8

Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 8 Swelling.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 1 Active knee flexion ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 3.1

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 1 Active knee flexion ROM ‐ short‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 2 Active knee flexion ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.2

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 2 Active knee flexion ROM ‐ medium‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 3 Active knee flexion ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 3.3

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 3 Active knee flexion ROM ‐ long‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 4 Pain ‐ short‐term effects.
Figuras y tablas -
Analysis 3.4

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 4 Pain ‐ short‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 5 Pain ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.5

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 5 Pain ‐ medium‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 6 Pain ‐ long‐term effects.
Figuras y tablas -
Analysis 3.6

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 6 Pain ‐ long‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 7 Function ‐ short‐term effects [standardised mean].
Figuras y tablas -
Analysis 3.7

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 7 Function ‐ short‐term effects [standardised mean].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 8 Function ‐ medium‐term effects [standardised mean].
Figuras y tablas -
Analysis 3.8

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 8 Function ‐ medium‐term effects [standardised mean].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 9 Function ‐ long‐term effects [standardised mean].
Figuras y tablas -
Analysis 3.9

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 9 Function ‐ long‐term effects [standardised mean].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 10 Quality of life ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.10

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 10 Quality of life ‐ medium‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 11 Quality of life ‐ long‐term effects [points].
Figuras y tablas -
Analysis 3.11

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 11 Quality of life ‐ long‐term effects [points].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points].
Figuras y tablas -
Analysis 3.12

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.13

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 14 Manipulation under anaesthesia [number].
Figuras y tablas -
Analysis 3.14

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 14 Manipulation under anaesthesia [number].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 15 Adverse events [number].
Figuras y tablas -
Analysis 3.15

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 15 Adverse events [number].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 16 Passive knee flexion ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 3.16

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 16 Passive knee flexion ROM ‐ short‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 17 Passive knee flexion ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.17

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 17 Passive knee flexion ROM ‐ medium‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 18 Passive knee flexion ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 3.18

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 18 Passive knee flexion ROM ‐ long‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 19 Active knee extension ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 3.19

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 19 Active knee extension ROM ‐ short‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 20 Active knee extension ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.20

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 20 Active knee extension ROM ‐ medium‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 21 Active knee extension ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 3.21

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 21 Active knee extension ROM ‐ long‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 22 Passive knee extension ROM ‐ short‐term effects.
Figuras y tablas -
Analysis 3.22

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 22 Passive knee extension ROM ‐ short‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 23 Passive knee extension ROM ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.23

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 23 Passive knee extension ROM ‐ medium‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 24 Passive knee extension ROM ‐ long‐term effects.
Figuras y tablas -
Analysis 3.24

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 24 Passive knee extension ROM ‐ long‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 25 Quadriceps strength ‐ short‐term effects [standardised mean].
Figuras y tablas -
Analysis 3.25

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 25 Quadriceps strength ‐ short‐term effects [standardised mean].

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 26 Length of hospital stay.
Figuras y tablas -
Analysis 3.26

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 26 Length of hospital stay.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 27 Swelling ‐ short‐term effects.
Figuras y tablas -
Analysis 3.27

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 27 Swelling ‐ short‐term effects.

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Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 28 Swelling ‐ medium‐term effects.
Figuras y tablas -
Analysis 3.28

Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 28 Swelling ‐ medium‐term effects.

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Summary of findings for the main comparison. Primary comparison for continuous passive motion (CPM) versus no CPM

Primary comparison for continuous passive motion (CPM) versus no CPM

Patient or population: hospitalised patients who have undergone knee replacement surgery
Settings: hospital
Intervention: Continuous passive motion (CPM) versus no CPM

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Primary comparison

Active knee flexion ROM
Goniometer. Scale: 0 to 130
Follow‐up: 6 weeks

The mean active knee flexion ROM in the control groups was
78 degrees

The mean active knee flexion ROM in the intervention groups was
2 higher
(0 to 5 higher)

‐

470
(10 studies)

⊕⊕⊕⊝
moderate1

Absolute risk difference 2% (0 to 4); relative percent change 0% (2 to 5); not statistically significant2

Pain
Visual analogue scale. Scale: 0 to 10 (lower score better)
Follow‐up: 6 weeks

The mean pain in the control groups was
3 points

The mean pain in the intervention groups was
0.4 lower
(0.8 lower to 0.1 higher)

‐

414
(8 studies)

⊕⊕⊝⊝
low1,3,4

Absolute risk difference ‐4% (‐8 to 1); relative percent change ‐80% (‐36 to 8); not statistically significant5

Function
Various. Scale: 0 to 100 (higher score better)
Follow‐up: 6 months

The mean function in the control groups was
56 points6

The mean function in the intervention groups was
1.6 lower
(6.1 lower to 2 higher)7

‐

405
(6 studies)

⊕⊕⊕⊝
moderate1,3

SMD ‐0.1 (‐0.3 to 0.1); absolute risk difference ‐2% (‐5 to 2); relative percent change ‐4 (‐12 to 5)8

Quality of life
SF‐12. Scale from: 0 to 100 (higher score better).
Follow‐up: 6 months

The mean quality of life in the control groups was
40 points

The mean quality of life in the intervention groups was
1 higher
(3 lower to 4 higher)

156
(2 studies)

⊕⊕⊕⊝
moderate1,3

Absolute risk difference 1% (‐3 to 4) ; Relative percent change ‐8% (‐8 to 13); non‐statistically significant9

Participants' global assessment of treatment effectiveness
Questionnaire. Scale: 0 to 7
Follow‐up: 6 weeks

See comment

See comment

Not estimable

211
(3 studies)

⊕⊝⊝⊝
very low1,3,10,11

Not estimable12

Manipulation under anaesthesia
Counts of manipulation under anaesthesia
Follow‐up: 6 weeks

72 per 1000

25 per 1000
(9 to 64)

RR 0.34
(0.13 to 0.89)

581
(8 studies)

⊕⊝⊝⊝
very low4,13,14

Absolute risk difference ‐4% (‐8 to 0); relative percent decrease ‐67% (‐87 to 11); NNTB 21 (16 to 126)

Adverse events
Counts of adverse events
Follow‐up: 6 weeks

163 per 1000

150 per 1000
(103 to 216)

RR 0.92
(0.63 to 1.33)

1040
(16 studies)

⊕⊕⊝⊝
low1,15

Absolute risk difference ‐1% (‐5 to 3); relative percent decrease ‐9% (‐37 to 33); not statistically significant

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; ROM: range of motion; RR: risk ratio; SF‐12: Short‐Form 12‐Item Health Survey.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 The methodological quality of at least some of the included trials were susceptible to bias.
2 Relative percentage change based on baseline mean of Sahin 2006 (105 degrees).
3 This outcome included self‐report from participants who were not blinded to the intervention. This can cause bias.
4 There are inconsistencies between the trials.
5 Relative percentage change based on baseline mean of Lenssen 2008 (1.05 points on a 0‐ to 10‐point scale converted from a 0‐ to 100‐points scale for consistency with other trials).
6 This is the mean final score of the control participants of Bennett 2005 (mean 56; standard deviation (SD) 21.63). Results are expressed in relationship to Knee Society Score (0‐ to 100‐point scale).
7 Estimate of the effect is back‐translated from standardised mean difference (SMD) ‐0.08 (95% confidence interval (CI) ‐0.27 to 0.12) using the baseline SD of Bennett 2005 (SD 20.19). Results are expressed in relationship to Knee Society Score (0‐ to 1000‐point scale).
8 Absolute risk difference is based on the mean and SD of the control group at baseline in Bennett 2005 (mean 45.3; standard error 2.8; SD 20.19). Results are expressed in relationship to Knee Society Score (0‐ to 100‐point scale).
9 Relative percentage change based on baseline mean of Maniar 2012 (30.58 points).
10 The point estimate of 1 trial favours the continuous passive motion (CPM) group and the point estimates of the other 2 trials favours the control group.
11 The 95% CI of the estimate of each trial is wide.
12 Data were not pooled.
13 It is not clear whether those making the decisions about the need for manipulation were blinded.
14 The CI for the risk ratio is wide.
15 The 95% CI associated with the risk ratio includes the possibility of an important increase and decrease in the risk of adverse events with CPM.

Figuras y tablas -
Summary of findings for the main comparison. Primary comparison for continuous passive motion (CPM) versus no CPM
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Table 1. Results from each electronic database for 2009‐2013 search

Database name, platform and time span

Update search date 

Number of results

The Cochrane Library, Issue 12, December 2012 from database inception

January 2009 to 24 January 2013

1

MEDLINE(R) Ovid 1966 to January week 3 2013 and MEDLINE(R) Ovid In‐Process & Other Non‐Indexed Citations 23 January 2013

January 2009 to 24 January 2013

126

EMBASE Ovid 1980  to 2013 week 3

January 2009 to 24 January 2013

146

EBSCOhost  CINAHL 1981 to 23 January 2013

January 2009 to 24 January 2013

1

AMED Ovid (Allied and Complementary Medicine Database) 1985 to January 2013

January 2009 to 24 January 2013

140

Physiotherapy Evidence Database (PEDro)

January 2009 to 24 January 2013

1

 ‐

TOTAL

415

 ‐

Total AFTER duplicates removed

 4

Figuras y tablas -
Table 1. Results from each electronic database for 2009‐2013 search
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Comparison 1. Main comparison

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Active knee flexion ROM ‐ short‐term effects Show forest plot

10

470

Mean Difference (IV, Random, 95% CI)

2.40 [‐0.22, 5.03]

2 Active knee flexion ROM ‐ medium‐term effects Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Active knee flexion ROM ‐ long‐term effects Show forest plot

3

132

Mean Difference (IV, Random, 95% CI)

2.85 [‐1.16, 6.87]

4 Pain ‐ short‐term effects Show forest plot

8

414

Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.84, 0.08]

5 Pain ‐ medium‐term effects Show forest plot

3

179

Mean Difference (IV, Random, 95% CI)

0.26 [‐0.41, 0.94]

6 Pain ‐ long‐term effects Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

7 Function ‐ short‐term effects [standardised mean] Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

8 Function ‐ medium‐term effects [standardised mean] Show forest plot

6

405

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.27, 0.12]

9 Function ‐ long‐term effects [standardised mean] Show forest plot

4

288

Std. Mean Difference (IV, Random, 95% CI)

0.02 [‐0.22, 0.25]

10 Quality of life ‐ medium‐term effects Show forest plot

2

156

Mean Difference (IV, Random, 95% CI)

0.75 [‐2.58, 4.08]

11 Quality of life ‐ long‐term effects Show forest plot

1

100

Mean Difference (IV, Fixed, 95% CI)

2.20 [‐3.90, 8.30]

12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points] Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects Show forest plot

1

60

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.74, 0.14]

14 Manipulation under anaesthesia [number] Show forest plot

8

581

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.13, 0.89]

15 Adverse events [number] Show forest plot

16

1040

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.63, 1.33]

16 Passive knee flexion ROM ‐ short‐term effects Show forest plot

11

697

Mean Difference (IV, Random, 95% CI)

2.03 [0.21, 3.86]

17 Passive knee flexion ROM ‐ medium‐term effects Show forest plot

4

264

Mean Difference (IV, Random, 95% CI)

‐1.85 [‐5.25, 1.55]

18 Passive knee flexion ROM ‐ long‐term effects Show forest plot

2

160

Mean Difference (IV, Random, 95% CI)

0.06 [‐2.22, 2.35]

19 Active knee extension ROM ‐ short‐term effects Show forest plot

11

574

Mean Difference (IV, Random, 95% CI)

0.85 [‐0.36, 2.06]

20 Active knee extension ROM ‐ medium‐term effects Show forest plot

4

195

Mean Difference (IV, Random, 95% CI)

0.77 [‐0.78, 2.31]

21 Active knee extension ROM ‐ long‐term effects Show forest plot

2

108

Mean Difference (IV, Random, 95% CI)

0.06 [‐0.06, 0.18]

22 Passive knee extension ROM ‐ short‐term effects Show forest plot

11

629

Mean Difference (IV, Random, 95% CI)

0.64 [‐0.26, 1.55]

23 Passive knee extension ROM ‐ medium‐term effects Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Totals not selected

24 Passive knee extension ROM ‐ long‐term effects Show forest plot

3

204

Mean Difference (IV, Random, 95% CI)

0.13 [‐0.34, 0.59]

25 Length of hospital stay Show forest plot

10

614

Mean Difference (IV, Random, 95% CI)

‐0.44 [‐1.03, 0.16]

26 Swelling ‐ short‐term effects Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Totals not selected

27 Swelling ‐ medium‐term effects Show forest plot

2

119

Mean Difference (IV, Random, 95% CI)

0.82 [‐1.14, 2.77]

28 Quadriceps strength ‐ short‐term effects [standardised mean] Show forest plot

2

130

Std. Mean Difference (IV, Random, 95% CI)

0.27 [‐0.08, 0.61]
Figuras y tablas -
Comparison 1. Main comparison
Ir a la tabla de la revisión
Comparison 2. Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Active knee flexion ROM Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Short‐term effects (< 6 wk)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Passive knee flexion ROM Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Short‐term effects (< 6 wk)

3

240

Mean Difference (IV, Random, 95% CI)

1.14 [‐1.09, 3.38]

2.2 Medium‐term effects (6 wk to 6 mo)

1

80

Mean Difference (IV, Random, 95% CI)

0.10 [‐4.11, 4.31]

2.3 Long‐term effects (> 6 mo)

1

80

Mean Difference (IV, Random, 95% CI)

‐0.5 [‐3.40, 2.40]

3 Active knee extension ROM Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Short‐term effects (< 6 wk)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Long‐term effects (> 6 mo)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Passive knee extension ROM Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Short‐term effects (< 6 wk)

3

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Medium‐term effects (6 wk to 6 mo)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4.3 Long‐term effects (> 6 mo)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Length of hospital stay Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

6 Function Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 Short‐term effect (< 6 wk)

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Medium‐term effects (6 wk to 6 mo)

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6.3 Long‐term effects (> 6 mo)

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Pain Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

7.1 Short‐term effects (6 wk to 6 mo)

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8 Swelling Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

8.1 Short‐term effects (6 wk to 6 mo)

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 2. Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises
Ir a la tabla de la revisión
Comparison 3. Main comparison ‐ sensitivity analysis using fixed‐effect model

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Active knee flexion ROM ‐ short‐term effects Show forest plot

10

470

Mean Difference (IV, Fixed, 95% CI)

2.29 [0.39, 4.20]

2 Active knee flexion ROM ‐ medium‐term effects Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Active knee flexion ROM ‐ long‐term effects Show forest plot

3

132

Mean Difference (IV, Fixed, 95% CI)

4.12 [2.22, 6.02]

4 Pain ‐ short‐term effects Show forest plot

8

414

Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐0.34, 0.05]

5 Pain ‐ medium‐term effects Show forest plot

3

179

Mean Difference (IV, Fixed, 95% CI)

0.04 [‐0.10, 0.18]

6 Pain ‐ long‐term effects Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7 Function ‐ short‐term effects [standardised mean] Show forest plot

4

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

8 Function ‐ medium‐term effects [standardised mean] Show forest plot

6

405

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.08 [‐0.27, 0.12]

9 Function ‐ long‐term effects [standardised mean] Show forest plot

4

288

Std. Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.22, 0.25]

10 Quality of life ‐ medium‐term effects Show forest plot

2

156

Mean Difference (IV, Fixed, 95% CI)

0.75 [‐2.58, 4.08]

11 Quality of life ‐ long‐term effects [points] Show forest plot

1

100

Mean Difference (IV, Fixed, 95% CI)

2.20 [‐3.90, 8.30]

12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points] Show forest plot

3

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects Show forest plot

1

60

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.74, 0.14]

14 Manipulation under anaesthesia [number] Show forest plot

8

581

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.11, 0.64]

15 Adverse events [number] Show forest plot

16

1040

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.75, 1.21]

16 Passive knee flexion ROM ‐ short‐term effects Show forest plot

11

697

Mean Difference (IV, Fixed, 95% CI)

2.01 [0.50, 3.52]

17 Passive knee flexion ROM ‐ medium‐term effects Show forest plot

4

264

Mean Difference (IV, Fixed, 95% CI)

‐1.69 [‐4.46, 1.08]

18 Passive knee flexion ROM ‐ long‐term effects Show forest plot

2

160

Mean Difference (IV, Fixed, 95% CI)

0.06 [‐2.22, 2.35]

19 Active knee extension ROM ‐ short‐term effects Show forest plot

11

574

Mean Difference (IV, Fixed, 95% CI)

1.18 [0.33, 2.02]

20 Active knee extension ROM ‐ medium‐term effects Show forest plot

4

195

Mean Difference (IV, Fixed, 95% CI)

0.74 [‐0.45, 1.92]

21 Active knee extension ROM ‐ long‐term effects Show forest plot

2

108

Mean Difference (IV, Fixed, 95% CI)

0.06 [‐0.06, 0.18]

22 Passive knee extension ROM ‐ short‐term effects Show forest plot

11

629

Mean Difference (IV, Fixed, 95% CI)

0.44 [‐0.12, 1.00]

23 Passive knee extension ROM ‐ medium‐term effects Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

24 Passive knee extension ROM ‐ long‐term effects Show forest plot

3

204

Mean Difference (IV, Fixed, 95% CI)

0.13 [‐0.34, 0.59]

25 Quadriceps strength ‐ short‐term effects [standardised mean] Show forest plot

2

130

Std. Mean Difference (IV, Fixed, 95% CI)

0.27 [‐0.08, 0.61]

26 Length of hospital stay Show forest plot

10

614

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.58, 0.19]

27 Swelling ‐ short‐term effects Show forest plot

5

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

28 Swelling ‐ medium‐term effects Show forest plot

2

119

Mean Difference (IV, Fixed, 95% CI)

0.72 [‐0.87, 2.31]
Figuras y tablas -
Comparison 3. Main comparison ‐ sensitivity analysis using fixed‐effect model
Ir a la tabla de la revisión