Document Title: Kocher-JKS-Apr03.shtml
Article Title: Effect of Functional Bracing on Subsequent Knee Injury in ACL-Deficient Professional Skiers
Authors: Mininder S. Kocher, MD, MPH, William I. Sterett, MD, Karen K. Briggs, MBA, David Zurakowski, PhD, J. Richard Steadman, MD
Publication: Journal of Knee Surgery
Date: April 2003
Volume 16, Number 2, pages 87-92
Keywords: knee-injury prevention, alpine skiing, ACL deficiency, functional knee bracing.

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Comments: In this study of ACL-deficient (without reconstruction) alpine skiers, Kocher et al. found an increased likelihood of re-injury in those who did not use functional knee bracing. They recommend the use of functional knee bracing for professional skiers (e.g. ski patrollers, ski instructors). The brace used in this study was the Innovation Sports CTi2, with no options (i.e. without the optional twist-controlling alpine-ski-boot attachment). It is reasonable to conclude that the findings of this study would apply to all custom-made dual-upright, full-tibial-shell functional knee braces (examples of which include, besides the ISI CTi2, the Townsend Air/Original, the DeRoyal Flextech F1, and the Karl Hager Double X). In fact, the study results probably apply to any brace which protects reliably against sideways forcing and injurious hyperextension (which includes nearly all functional braces, potentially including off-the-shelf models [if properly fitted to the leg]).

ABSTRACT: The effect of functional bracing on subsequent knee injury in anterior cruciate ligament (ACL) deficient professional skiers was evaluated. A cohort of 180 ACL-deficient skiers was identified from a knee screening of 9410 professional skiers from 1991-1997. An ACL-deficient knee was defined by an abnormal examination (Lachman or pivot-shift) and a greater than or equal to 5-mm KT-1000 manual maximum difference. The dependent variable was subsequent knee injury, which occurred in 12 knees. A significantly higher proportion of injuries occurred in nonbraced skiers compared with braced skiers (P=.005). The risk ratio for subsequent knee injury comparing nonbraced with braced skiers was 6.4 (13% and 2%, respectively). Univariate analysis revealed no significant effects of the other covariates. Logistic regression identified bracing status (P<.01; odds ratio=8) and KT-1000 manual maximum difference (P=.02; odds ratio=1.3) as significant multivariate risk factors for subsequent knee injury, controlling for covariates.

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