The Effectiveness of Bracing After ACL Reconstruction

The Effectiveness of Bracing After ACL Reconstruction

Conclusion

Study 1

• All valid studies reported that there is not a significant difference between bracing after ACL reoncstruction and not bracing.
• Studies that supported non-bracing were biased and invalid

• Patients who braced after ACL reconstruction were compared with those who did not in a systamatic review
• The outcomes assessed across the included studies were range of motion (ROM), KT 1000, isokinetic testing, Lysholm score, Tegner activity scale, laxity, International Knee Documentation Committee 1991 score, Cincinnati (ect..)

Bibliography

Results:

http://www.ncbi.nlm.nih.gov/pubmed/9934423

http://eagle.sbuniv.edu:2298/eds/pdfviewer/pdfviewer?sid=a0021ca6-84e3-4ad3-96d8-4c3f773cd5f4%40sessionmgr198&vid=3&hid=101

Results

http://www.universityorthopaedic.com/forms/KneeACL.pdf

ACL Reconstruction

http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?sid=cb9f3b27-392d-4e0a-8362-527dd53a528e%40sessionmgr4005&vid=3&hid=4210

• At all follow up times there were no significant differences between the two groups
• The Cincinatti knee scored showed signifiantly greater function in the braced group despite signifigantly greater atrophy than the non-braced group

The controversy

• The findings were not significant, and most of the tudies were biased
• There was not enough evidence to support the idea that bracing is less effective than not bracing
• Patients who braced reported less pain and ROM was slightly less than those who did not brace, but not signifigant enough to make a case

• After the ACL has been torn, it is surgically reconstructed
• The most common method for reconstructing the ACL is by using a graft from the patellar tendon to create a new ACL

Study 2

The ACL

• New research suggests that bracing after ACL reconstruction is actually less benneficial in reaching full extension and prolongs rehabilitation of the knee
• The brace is usually locked in a 0, -5 or -10 degrees of hyperextension to maintain extension while the athlete is not doing therapy

• 60 patients were reandomized into two groups, one group braced after reconstruction and one did not.
• Both groups were evaluated using the same tests as study 1
• evaluation checkpoints were 6 weeks,3 and 6 months and 1 and 2 years

• The anterior cruciate ligament is one of the four ligaments in the knee that stabilize the knee.
• It attatches to the anteiror aspect of the femur and reaches back to the poserior aspect of the tibia.
• The main mechanism of injury for a torn ACL in athletics is a planting, twisting motion.

The Importance Extension:

• Extension in the early phase of rehabilitation is pivitol becasue as time goes on, the knee will begin to naturally flex as muscles begin to atrophy and weakness occurs with limited use.
• Keeping the knee in extesion keeps tension off of the ACL graft and promotes more mobility within the capsul

Bracing

• In the past, plaster casts were used to immobilize the knee after surgery
• Today adjustable braces are used to promote early mobilization and weight bearing
• Derotation braces are most commonly used today after ACL reconstruction

Rhabilitation

• Typical rehab after ACL surgery will last about 6-9 months and consists of early mobilizaion, ROM, hyperextension, weight-bearing, muscle-strengthening, proprioception, and functional exercises or training
• A brace with adjustable hinges is typically used to stabilize the knee and promote extension after surgery