Ask a Vail Sports Doc column: Should I wear a knee brace after ACL surgery?
Ask a Vail Sports Doc
This past winter, I saw a large number of ACL tears.
Anatomic ACL reconstruction surgery of the knee has been shown to improve knee kinematics, slow the progression of osteoarthritis in the knee and allow athletes to return to sports without further giving way episodes of the knee. The risk of repeat injury to the affected knee and also injury to the other normal knee is increased in the first year following ACL surgery, as it can take that long to regain full strength and for the graft to fully incorporate in the knee.
The use of knee braces after ACL surgery is common. Recently, a study which polled a large group of sports medicine orthopedists found that 63 percent recommended a brace to their patients after ACL surgery. Braces have been thought to help protect the ACL graft by minimizing abnormal forces across the knee and to improve patient confidence. Possible disadvantages of knee bracing include the fact one can still tear their ACL while wearing a brace, the perception that a brace may lead to muscle weakness or that it prevents peak performance, and additional cost.
Benefits of braces
Patients often ask me if they should wear a knee brace after their ACL reconstruction. The correct answer is somewhat elusive as the studies have been mixed on this topic. Recently, a study was published that looked at the best 15 studies that addressed this question. A few important take home points came out of this study.
As for kinematics (the science of motion), moderate evidence showed that functional braces may reduce tibial translation and rotation. Excessive translation and rotation can lead to ACL tears.
Concerning strength, the results were mixed with some studies showing a decrease in leg muscle strength when braces were used while others not showing this to be the case.
As for function, there were no significant differences in joint laxity or range of motion of the knee when comparing the braced and non braced group.
Concerning subjective clinical outcomes, patients who wore a brace did report more confidence in the knee and this was thought to be due to improved proprioception and sensation.
In summary, this study does suggest that postoperative bracing after ACL reconstruction surgery may improve joint kinematics without reducing sports performance. This may lead to lower re-tear rates of one’s ACL graft although this has not yet been validated.
In my own practice, I will continue to recommend that my patients who have undergone an ACL reconstruction or an ACL repair surgery wear a functional knee brace for the first year back to cutting and pivoting sports. They do not need it for activities such as biking and hiking, but I do recommend it for sports such as skiing, snowboarding, soccer and basketball.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics and a physician for the U.S. Ski Team. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at http://www.vailknee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.
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