AOSSM: Flexible Knee Support after ACL Surgery as Good as Hard Brace

CALGARY, Alberta, July 12 -- An elastic neoprene sleeve may be just as good as a hard knee brace for most patients returning to sports after anterior cruciate ligament (ACL) surgery, researchers said.

Patients who used a neoprene sleeve during physical activity after ACL reconstruction had no significant differences in knee stability, limb symmetry, or quality of life compared with those who used a functional knee brace, found Trevor Birmingham, Ph.D., P.T., of the University of Western Ontario in London, Ontario, and colleagues in a randomized controlled trial.

"The average patient returning to physical activities after ACL reconstruction does not require a functional knee brace," he said here at the American Orthopedic Society for Sports Medicine meeting.

Rigid support has widely been thought necessary to protect the reconstructed ligament by restraining the knee from abnormal movement that could put excessive strain on the ACL or graft, despite lack of evidence for their effectiveness, he said.

He cited a recent survey in which 63% of surgeons said they recommend rigid bracing for their patients.

Neoprene sleeves only compress the area around the knee to improve neuromuscular control.

To address whether a less expensive and restrictive orthosis would be sufficient, the researchers studied 150 athletes preparing to return to sports six weeks after primary ACL reconstruction.

They randomized 76 patients to receive a functional knee brace and 74 to receive a neoprene sleeve for use during all physical activities.

There were no statistically or clinically significant differences between groups in outcomes at one- or two-year assessments administered by a researcher blinded to orthosis use.

At two years, the between-group differences adjusted for baseline scores were:

• 0.9 on a 100-point scale for disease-specific quality of life (95% confidence interval -6 to 8).
• 0.1 mm for side-to-side stability measured with a KT1000 arthrometer (95% CI -1 to 1).
• 1% on the hop limb symmetry index (95% CI -7 to 9).
• -0.05 on the 10-point Tegner Activity Scale (95% CI -0.72 to 0.62).

Likewise, there were no significant differences in subgroups based on time from ACL injury to surgery, preoperative knee stability score, and compliance with brace or sleeve use during sports at one and two years.

However, women younger than 25 had better quality of life scores with the brace than the sleeve (difference 14 points, 95% CI 2 to 27, P=0.02).

Adverse events were similar between groups as well.

"These findings suggest a functional knee brace does not result in superior outcomes over a neoprene sleeve following ACL reconstruction," the researchers said.

However, Dr. Birmingham acknowledged that the study could not address whether either type of knee support was better than none, but he said the results were not surprising based on his clinical experience.

The findings would likely be generalizable because previous studies have shown similar outcomes across types of hard braces and sleeves, he said.

Nevertheless, he said, the decision is left to the surgeon's discretion until further studies clarify which patients may still benefit from a brace, he concluded.