COLUMBUS, Ohio -- It may be unnecessary for athletes to fasten themselves into cumbersome braces after a specific reconstructive knee surgery, new research suggests.
Injuries to the anterior cruciate ligament (ACL), which stretches across the knee joint, are especially common among athletes whose sports involve jumping, turning and abrupt starts and stops. Part of the rehabilitation process includes wearing a knee brace for up to a year.
“We didn’t notice any difference after surgery between patients who wore braces and patients not wearing braces,” said Christopher Kaeding, associate professor of surgery at Ohio State University. “Our study implies a brace may be unnecessary after ACL reconstruction.”
Kaeding and his colleagues compared the rehabilitation rates of 77 patients that underwent ACL reconstructive surgery. The 47 patients assigned to wear a knee brace fared no better overall than the 30 given a pull-on elastic knee bandage, or sleeve. In fact, patients without the brace seemed slightly happier at not having to wear one.
Kaeding presented the results of the study at a recent meeting of the American Orthopaedic Society for Sports Medicine.
An ACL injury is a torn ligament that causes the knee to be loose. It is the most common devastating knee injury to athletes, according to Kaeding. Braces have been thought to protect the ACL-injured knee during rehabilitation.
“ACL braces were designed to stabilize the knee, to make it feel more trustworthy,” said Kaeding, who sees more than 200 ACL injuries each year. “The braces do seem to help some patients who haven’t had the surgery but have damaged their ACL.”
Reconstructive knee surgery improved significantly about 10 years ago. Before that, physicians depended on casts, splints and braces to protect the healing ligament by preventing a wide range of motion. Despite more aggressive rehabilitation in recent years, brace use was still thought to be necessary.
“The mind set was to protect the graft,” Kaeding said. “Yet a couple of years ago, my colleagues and I noticed some patients weren’t wearing their knee braces. And these patients were doing great.”
All patients in the current study underwent tests to determine the stability of the knee joint at three weeks and three, six and 12 months after surgery. Patients with the braces were told to wear their braces during sports and other physical activity for at least a year. The group with the sleeves could wear these when they wished.
An ACL reconstruction is designed to restore knee stability. When the ACL tears, the forward motion of the tibia, or shin bone, greatly increases in relation to the femur, or thigh bone. This causes pain and difficulty in using the knee. Successful ACL reconstruction restores near-normal tightness and stability in the knee.
“Both groups in our study were in the excellent recovery range after 12 months,” Kaeding said. “This study implies that a brace doesn’t seem to contribute that much to the protection of a knee after ACL reconstruction.
“And that’s the trend among knee surgeons across the country. This study doesn’t buck the trend, but it is the first time somebody has documented evidence that shows braces may not be helpful.”
Co-authors for this study include Aasha Sinha, of the Division of Orthopaedic Surgery at Ohio State; Rose Backs, an athletic trainer at Ohio State’s University Sports Medicine Center; and Matthew Schatzke, also an athletic trainer.