An article published in the Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) by Mayr et al in late 2013 concluded post-operative treatment with a stabilizing knee brace after ACL replacement showed no advantage over treatment without a brace at 4-year follow-up. The study allocated 64 patients into two groups. One group was instructed to wear a brace for the first six weeks following surgery while the other group was instructed not to. Both groups completed the same physical therapy protocol. The authors present the results of a clinical examination at 4 years following the index surgery as well as the measurements of various patient outcome scores. Eighty-one percent (n=52) of patients were examined at 4 years post-op. There was no significant difference between the two groups with the use of the IKDC 2000, the KT1000 device, and the Tegner and Lysholm activity scores. Interesting enough, the authors did demonstrate a better score in the Visual Analogue Scale (VAS) of pain during sports and strong physical activity subscale in the group allocated to not use a brace (p=0.015). Do you use a brace after surgery with your patients?
Department of Orthopedic and Trauma Surgery, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany, firstname.lastname@example.org.
- A controversial discussion is held on using stabilizing knee braces after anterior cruciate ligament (ACL) surgery. The current study investigated the influence of a stabilizing knee brace on results after ACL reconstruction using patellar tendon autografts.
- A prospective randomized study was started including 64 patients divided into two equal groups and treated with or without a stabilizing knee brace for 6 weeks post-operatively. A follow-up examination 4 years after operation comprised IKDC 2000, KT1000 measurement, a visual analogue pain scale (VAS; scores 0-10) and radiographic evaluation. The t test for independent and paired samples and the Pearson's Chi-square test were used for statistical analysis (p < 0.05). The primary endpoint was the difference in IKDC classification.
- Eighty-one per cent of the patients were examined 4 years post-operatively. IKDC 2000 subjective (brace group 90.5 ± 8.9, braceless group 93.2 ± 6.1) and objective results (brace A 30%, B 56%, C 16%; braceless A 32%, B 48%, C 20%) and instrumental measurement of anteroposterior laxity with KT1000 (brace 0.6 ± 2.4 mm, braceless 1.8 ± 3.4 mm) showed no significant differences. VAS pain results were significantly better in the braceless group at 1.0 ± 1.2 versus 1.9 ± 1.4 under sports activity or heavy physical work (p = 0.015). There were no radiographic differences concerning osteoarthritic findings and tunnel widening between the groups.
- Post-operative treatment with a stabilizing knee brace after ACL replacement showed no advantage over treatment without a brace at 4-year follow-up. The use of a knee-stabilizing brace after isolated ACL reconstruction with autologous patellar tendon graft is not recommended.
- LEVEL OF EVIDENCE