Effectiveness of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Systematic Review

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.