Question: Is functional bracing more effective than nonbracing after anterior cruciate ligament (ACL) reconstruction in patients with
a high level of physical activity?
Design: Randomized (allocation not concealed), unblinded, controlled trial with a mean 29-month follow-up.
Setting: 3 United States military academies.
Patients: 100 cadets and midshipmen with ACL injury, no previous knee injury to the affected knee, no significant chondral injury, no grade-III posterior cruciate or collateral ligament injuries, no serious meniscal injury, surgical reconstruction within 8 weeks of injury, and available for follow-up for ≥2 years.
Intervention: Patients were allocated to wear (n = 47) or not wear a brace (n = 48). The braced group wore a DonJoy IROM brace (dj Orthopaedics, Vista, California) locked in extension for 3 weeks after surgery (removed 2 to 3 times daily for physical therapy) and adjusted to allow for increasing range of motion during the 3 to 6 weeks after surgery. At 6 weeks, patients wore an off-the-shelf func- tional knee brace daily for 6 months and for rigorous activities for ≥1 year. Patients in the nonbrace group wore a knee immobilizer for 3 weeks after surgery (removed for physical therapy). Postoperative rehabilitation for all patients included range-of-motion exercises, cycling on a stationary bicycle, pool exercises, strengthening exercises, and functional training.
Main outcome measures: Measures of stability, function, and strength of the affected knee (range of motion, prone heel height difference, isokinetic testing, single-legged hop for dis- tance, Lysholm score, KT-1000 arthrometer testing, International Knee Documentation Committee score, Lachman test, pivot shift test, and knee radiographs). The study was powered to detect a 20% difference in Lysholm score.
Main results: Patients who were braced and those who were not braced did not differ for any outcomes (Table). Knee radiographs were normal in both groups of patients. One patient in the nonbraced group could not return to the same level of sport activity. Two braced and 3 nonbraced patients had re-injury to the affected knee.
Conclusion: In patients with a high level of physical activity, the outcomes with regard to stability, function, and strength were not sig- nificantly different between patients who did or did not wear a brace after anterior cruciate ligament reconstruction.