Document Title: McDevitt-AJSM-Dec04.shtml
Article Title: Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Multicenter Study
Authors: Edward R. McDevitt, CPT (Retired), MC, USN, Dean C. Taylor, COL, MC, USA, Mark D. Miller, MD, LTC, MC, USAF Reserve, John P. Gerber, MAJ, SP, USA, Gregg Ziemke, CDR, MSC, USN*, Daniel Hinkin, LTC (Retired), MC, USAFll, John M. Uhorchak, COL (Retired), MC, USA, Robert A. Arciero, COL (Retired), MC, USA and Patrick St. Pierre, COL (Retired), MC, USA
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: December 2004
Volume 32, pages 1887-1892
Keywords: functional knee bracing, ACL reconstruction.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form. This article contains neither tables nor figures.)

Comments: This study looks at young military-academy people who underwent ACL reconstruction; half of these people used knee bracing (rehabilitative/postoperative brace after surgery, followed by an off-the-shelf functional brace worn daily starting at 6 weeks and carrying on until 6 months post-op (and thereafter during strenuous activities only); the other half used a knee immobilizer (removed for exercises thrice daily) for three weeks. The authors found no difference in clinical outcome between the two groups, but they did note that their population size is too small to conclude that functional bracing does not influence the reinjury or complication rates after ACL reconstruction. It would have been interesting to have had more information regarding the mechanisms of injury pertaining to the "subsequent injuries" section, in particular the ACL-graft tears noted in two nonbraced people; because functional braces protect very reliably against sideways forcing and injurious hyperextension, if the subsequent injuries in these two nonbraced people were of these types, then bracing would indeed have prevented these injuries. Another thought-provoking aspect about this study is that the functional braces used were of the off-the-shelf variety only. (Because different braces employ different designs, materials, and construction, the protective capabilities of the various off-the-shelf braces on the market at not all the same. It would have been nice to know the make/model of functional brace used, but this information might have been deliberately omitted. Only the make/model of rehabilitative brace was given.) Given that there are always some people who have legs shaped in a way that is wholly or partly incompatible with off-the-shelf bracing, it seems very improbable that all the people in the braced group would have happened to have been endowed with leg sizes/shapes that were truly suited to comfortable wearing of off-the-shelf bracing. Since all members of the braced group were expected to wear their knee braces on a daily basis until six months post-op, one would have expected that custom-made knee bracing would have at least been offered to those with non-average leg shapes. Because all-day wearing of bracing requires the brace to fit perfectly and be comfortable, the fact that exclusively off-the-shelf braces were provided raises the question of whether 100% of the members of the braced group were diligent in wearing their braces as instructed. And finally, the study's approach to bracing is a bit disappointing in that it treats functional knee bracing as a "black box". Simply giving a patient a functional brace and saying "here it is, wear it" is inherently inadequate. Rather, the patient must understand the limitations and capabilities of the brace, as well as the underlying reasons therefor. In particular, the patient should be reminded that because of the bone-surrounding shear-prone soft tissues of the leg, it is inherently inappropriate to expect a used-in-isolation brace to protect against twisting-type knee injuries.

ABSTRACT

Background: Bracing after anterior cruciate ligament reconstruction is expensive and is not proven to prevent injuries or influence outcomes.

Purpose: To determine whether postoperative functional knee bracing influences outcomes.

Study Design: Prospective, randomized, multicenter clinical trial.

Methods: One hundred volunteers from the 3 US service academies with acute anterior cruciate ligament tears were randomized into braced or nonbraced groups. Only those subjects with anterior cruciate ligament tears treated surgically within the first 8 weeks of injury were included. Patients with chondral injuries, significant meniscal tears, or multiple knee ligament injuries were excluded. Surgical procedures and the postoperative physical therapy protocols were identical for both groups. The braced group was instructed to wear an off-the-shelf functional knee brace for all cutting, pivoting, or jumping activities for the first year after surgery.

Results: Ninety-five subjects were available with a minimum 2-year follow-up. There were no statistically significant differences between groups in knee stability, functional testing with the single-legged hop test, International Knee Documentation Committee scores, Lysholm scores, knee range of motion, or isokinetic strength testing. Two braced subjects had reinjuries, and 3 nonbraced subjects had reinjuries.

Conclusions: In this young, active population, postoperative bracing does not appear to change the clinical outcomes after anterior cruciate ligament reconstruction.

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