Effectiveness of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Systematic Review
- Journal
- Journal of clinical medicine (Q1)
- Published
- 16 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Papi Davide, Carulli Christian, Lorenzoni Niccolo', Montigiani Giulia
- PMID
- 42513489
- DOI
- 10.3390/jcm15145575
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 29 July 2026).
- Picked for Rehabilitation (paper of the day, 29 July 2026).
Abstract
Background/Objectives: Total Knee Arthroplasty (TKA) is the gold-standard treatment for end-stage knee osteoarthritis. After surgery, the natural onset of edema and pain usually influences the early functional recovery. Manual Lymphatic Drainage (MLD) has been proposed as a possible adjunct rehabilitation strategy in the immediate management of the operated joint. This review aimed to assess the effectiveness of MLD during early rehabilitation after TKA. Methods: Searches were conducted in PubMed, Embase, CINAHL, and Google Scholar up to June 2025. Eligible studies were randomized controlled trials (RCTs) comparing MLD with non-MLD interventions (standard physiotherapy, Kinesiotaping, and negative-pressure devices). An exploratory meta-analysis using a random-effects model was performed. The primary outcome was postoperative edema reduction; secondary outcomes were the effects on pain and range of motion (ROM). Results: Eight RCTs (n = 463 participants) met the inclusion criteria. Edema data were insufficient for reliable quantitative synthesis (two poolable studies; SMD = -1.08 and +0.20; I2 = 78.1%). MLD did not yield consistent improvements in AROM (SMD = 0.15; 95% CI: -0.08 to 0.37; I2 = 0.0%) or pain. Two studies reported modest, short-lived benefits in the first postoperative days. No treatment-related adverse events were reported. Conclusions: Available evidence does not support the routine use of MLD as a primary intervention after TKA. Owing to its excellent safety profile, MLD may be considered selectively within a multimodal rehabilitation program as an adjunctive comfort-enhancing intervention, particularly for patients with low exercise tolerance. Further high-quality RCTs with standardized protocols are needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.