Monday, November 14, 2011

Functional Knee Brace after Anterior Cruciate Ligament Reconstruction not recommended.

I have often expressed my personal dislike of the over use of bracing in general and feel that in most cases it is over utilized. This study supports my previous statements that functional knee brace's are not helpful and we should focus on Rehabilitation not bracing.

A Randomized Controlled Trial Comparing the Effectiveness of Functional Knee Brace and Neoprene Sleeve Use After Anterior Cruciate Ligament Reconstruction

Trevor B. Birmingham, PhD†,‡,*,

Dianne M. Bryant, PhD†,‡,

J. Robert Giffin, MD, FRCS(C)†,‡,

Robert B. Litchfield, MD, FRCS(C)†,‡,

John F. Kramer, PhD‡,

Allan Donner, PhD‡, and

Peter J. Fowler, MD, FRCS(C)†,‡

+Author Affiliations

From the ^†Fowler Kennedy Sport Medicine Clinic, and the ^‡University of Western Ontario, London Ontario, Canada

Address correspondence to Trevor B. Birmingham, PhD, School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6G 1H1 (e-mail: tbirming@uwo.ca).

Abstract

Background: Despite a lack of evidence for their effectiveness, functional knee braces are commonly prescribed to patients after anterior cruciate ligament (ACL) reconstruction.

Purpose: This trial was conducted to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve.

Hypothesis: Patients using a brace will have superior outcomes than those using a sleeve.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: One hundred fifty patients were randomized to receive a brace (n = 76) or neoprene sleeve (n = 74) at their 6-week postoperative visit after primary ACL reconstruction with hamstring autograft. Patients were assessed preoperatively, then 6 weeks and 6, 12, and 24 months postoperatively. Outcome measures included disease-specific quality of life (Anterior Cruciate Ligament–Quality of Life [ACL-QOL] Questionnaire), anterior tibial translation (KT-1000 arthrometer side-to-side difference), the single-limb forward hop test (limb symmetry index), and Tegner Activity Scale. Outcomes at 1 and 2 years were compared after adjusting for baseline scores. Subjective ratings of how patients felt while using the brace/sleeve were also collected for descriptive purposes using a questionnaire. Four a priori directional subgroup hypotheses were evaluated using tests for interactions.

Results: There were no significant differences between brace (n = 62) and sleeve (n = 65) groups for any of the outcomes at 1- and 2-year follow-ups. Adjusted mean differences at 2 years were as follows: −0.94 (95% confidence interval [CI], −7.52 to 5.64) for the ACL-QOL Questionnaire, −0.10 mm (95% CI, −0.99 to 0.81) for KT-1000 arthrometer side-to-side difference, −0.87% (95% CI, −8.89 to 7.12) for hop limb symmetry index, and −0.05 (95% CI, −0.72 to 0.62) for the Tegner Activity Scale. Subjective ratings of confidence in the knee provided by the brace/sleeve were higher for the brace group than the sleeve group. Subgroup findings were minimal. Adverse events were few and similar between groups.

Conclusions: A functional knee brace does not result in superior outcomes compared with a neoprene sleeve after ACL reconstruction. Current evidence does not support the recommendation of using an ACL functional knee brace after ACL reconstruction.