LONDON, Ontario, Canada—Functional knee braces are no better than neoprene sleeves at protection knees after anterior cruciate ligament (ACL) reconstruction, according to Trevor B. Birmingham, PhD, Peter J. Fowler, MD, and colleagues at the Fowler Kennedy Sport Medicine Clinic and the University of Western Ontario in Canada. Their randomized, controlled trial reported in the American Journal of Sports Medicine¹ is the third major study to challenge the value of knee bracing following ACL repair.^2,3

"Current evidence does not support the recommendation of using an ACL functional knee brace after ACL reconstruction," Dr. Birmingham concluded.

Time to dump the brace?

The investigators randomized patients to receive a brace or a neoprene sleeve 6 weeks after primary ACL reconstruction with hamstring autograft. ACL quality of life, ligament laxity, single-limb forward hop, and activity levels were assessed at 6, 12, and 24 months after surgery, as well as subjective ratings of the brace or sleeve.

"There were no significant differences between brace (n = 612) and sleeve (n = 65) groups for any of the outcomes at 1- and 2-year follow-ups," the authors report. Subjective ratings of confidence in the knee were higher for the brace group, but Dr. Birmingham points out that this may not be a good thing, since it "may produce a false sense of confidence in the knee when returning to sport after ACL reconstruction and may in fact have negative consequences."

Rigid, functional knee braces are meant to protect the ACL reconstruction graft from excessive strain and elongation during strenuous activities, but this study found no difference in graft elongation between the brace and sleeve groups.

Translating research into practice

A related study by McDevitt et al that compared bracing after ACL reconstruction to no bracing found no advantage to using the brace.² That study, which was done in 100 otherwise healthy young patients from three US service academies, concluded, "In this young, active population, postoperative bracing does not appear to change the clinical outcomes after anterior cruciate ligament reconstruction."

A systematic review of 12 randomized, controlled trials by Wright and Fetzer noted, "Clinicians have believed braces improve the outcome of ACL reconstruction by improving extension, decreasing pain and graft strain, and providing protection from excessive force." However, the reviewers found "no evidence that pain, range of motion, graft stability, or protection from subsequent injury were affected by brace use...."

Dr. Birmingham commented, "The trial by McDevitt et al demonstrated similar outcomes between braced and unbraced patients; the results of our study and the McDevitt study together suggest that similar outcomes may be expected for patients who use a knee orthosis and those who do not."

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