Effect of Functional Bracing on Knee Injury in Skiers With Anterior Cruciate Ligament Reconstruction

Abstract

Background:The role of knee bracing in anterior cruciate ligament reconstructions is controversial.

Hypothesis:Functional bracing will have an effect on subsequent knee injury in skiers with anterior cruciate ligament reconstruction.

Study Design: Cohort study; Level of evidence,3.

Methods:From 1991 to 1997, 11606 skiers at a major destination ski resort underwent preseason knee screening. The anterior cruciate ligamentreconstructed group consisted of 820 skiers who had had an anterior cruciate ligament reconstruction 2 years or more earlier. Of these, 257 skiers selected the use of functional knee brace during skiing. The dependent variable was subsequent knee injury, identified via workers compensation records. Covariates included age, gender, ski occupation, Lachman grade, pivot-shift grade, KT-1000 arthrometer manual maximum displacement, and use of a functional brace. Univariate and multivariate risk factors for subsequent knee injury were determined.

Results:In this study, 257 skier-employees with anterior cruciate ligament reconstruction wore braces and 563 skier-employees with anterior cruciate ligament reconstruction did not. Braced skiers had significantly higher preseason rates of grade II or higher Lachman and pivot-shift tests (braced, 29% and 22%, respectively; nonbraced, 11% and 10%, respectively;P > .05). Sixty-one subsequent knee injuries were identified, 51 (8.9 injuries/100 knees/ski season) in the nonbraced group and 10 (4.0 injuries/100 knees/ski season) in the braced group (P= .009). Nonbraced skiers were 2.74 times more likely to suffer subsequent injury than were braced skiers (odds ratio, 2.74 [confidence interval, 1.2-4.9]). Logistic regression modeling identified nonbracing as a significant independent multivariate risk factor for subsequent knee injury in the high-demand skiers with anterior cruciate ligament reconstruction.

Conclusion: Because of the increased risk of subsequent knee injury in nonbraced skiers, the authors recommend functional bracing for skiers with anterior cruciate ligament reconstruction. Whether the protective effect of functional bracing can be extrapolated to other high-demand patients is yet to be determined.

Keywords

functional bracing anterior cruciate ligament(ACL)reconstruction knee injury

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References

Albright JP

Saterbak A

Stokes J

. Use of knee braces in sport: current recommendations. Sports Med. 1995;20:281-301.

American Academy of Orthopaedic Surgeons

. Knee Braces: Seminar Report. Chicago, Ill: American Academy of Orthopaedic Surgeons; 1985.

Bassett GS

Fleming BW

. The Lenox Hill brace in anterolateral rotatory instability. Am J Sports Med. 1983;11:345-348.

Beck C

Drez D Jr

Young J

Cannon WD Jr

Stone ML

. Instrumented testing of functional knee braces. Am J Sports Med. 1986;14:253-256.

Beynnon BD

Good L

Risberg MA

. The effect of bracing on proprioception of knees with anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2002;32:11-15.

Beynnon BD

Johnson RJ

. Anterior cruciate ligament injury rehabilitation in athletes: biomechanical considerations. Sports Med. 1996;22:54-64.

Birmingham TB

Kramer JF

Kirkley A

. Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil. 2002;83:1472-1475.

Branch TP

Hunter R

Donath M

. Dynamic EMG analysis of anterior cruciate deficient legs with and without bracing during cutting. Am J Sports Med. 1989;17:35-41.

Branch TP

Hunter R

Reynolds P

. Controlling anterior tibial displacement under static load: a comparison of two braces. Orthopedics. 1988;11:1249-1252.

10.

Cawley PW

France EP

Paulos LE

. The current state of functional knee bracing research: a review of the literature. Am J Sports Med. 1991;19:226-233.

11.

Colville MR

Lee CL

Ciullo JV

. The Lenox Hill brace: an evaluation of effectiveness in treating knee instability. Am J Sports Med. 1986;14: 257-261.

12.

Cook FF

Tibone JE

Redfern FC

. A dynamic analysis of a functional brace for anterior cruciate ligament insufficiency. Am J Sports Med. 1989;17:519-524.

13.

Coughlin L

Oliver J

Berretta G

. Knee bracing and anterolateral rotatory instability. Am J Sports Med. 1987;15:161-163.

14.

Decoster LC

Vailas JC

. Functional anterior ligament bracing: a survey of current brace prescription patterns. Orthopedics. 2003;26:701-706.

15.

Delay BS

Smolinski RJ

Wind WM

Bowman DS

. Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. Am J Knee Surg. 2001;14:85-91.

16.

Devita P

Hunter PB

Skelly WA

. Effects of a functional knee brace on the biomechanics of running. Med Sci Sports Exerc. 1992;24:797-806.

17.

Devita P

Torry M

Glover KL

Speroni DL

. A functional knee brace alters joint torque and power patterns during walking and running. J Biomech. 1996;29:583-588.

18.

France EP

Paulos LE

. Knee bracing. J Am Acad Orthop Surg.1994;2: 281-287.

19.

France EP

Paulos LE

Jayaraman G

Rosenberg TD

. The biomechanics of lateral knee bracing, part II: impact response of the braced knee. Am J Sports Med. 1987;15:430-438.

20.

Hefti F

Muller W

Jakob RP

Staubli HU

. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1:226-234.

21.

Houston ME

Goemans PH

. Leg muscle performance of athletes with and without knee support braces. Arch Phys Med Rehabil.1982;63: 431-432.

22.

Jonsson H

Karrholm J

. The stabilizing effect of the knee braces after anterior cruciate ligament rupture. Acta Orthop Scand Suppl.1989;231:29-29.

23.

Knutzen KM

Bates BT

Schot P

Hamill J

. A biomechanical analysis of two functional knee braces. Med Sci Sports Exerc. 1987;19:303-309.

24.

Kocher MS

Sterett WI

Briggs KK

Zurakowski D

Steadman JR

. Effect of functional bracing on subsequent knee injury in ACL deficient professional skiers. J Knee Surg. 2003;16:87-92.

25.

Mishra DK

Daniel DM

Stone ML

. The use of functional knee braces in the control of pathologic anterior laxity. Clin Orthop Relat Res. 1989;241:213-220.

26.

Oates KM

Van Eenenaam DP

Briggs K

Homa K

Sterett WI

. Comparative injury rates of uninjured, anterior cruciate ligament–deficient, and reconstructed knees in a skiing population. Am J Sports Med. 1999;27:606-610.

27.

Paulos LE

France EP

Rosenberg TD

Jayaraman G

Abbott PJ

Jaen J

. The biomechanics of lateral knee bracing, part I: response of the valgus restraints to loading. Am J Sports Med. 1987;15:419-429.

28.

Rink PC

Scott RA

Lupo RL

Guest SJ

. Team physician #7: a comparative study of functional bracing in the anterior cruciate deficient knee. Orthop Rev. 1989;18:719-727.

29.

Sitler M

Ryan J

Hopkinson W

, et al. The efficacy of a prophylactic knee brace to reduce knee injuries in football: a prospective, randomized study at West Point. Am J Sports Med. 1990;18:310-315.

30.

Tegner Y

Lysholm J

. Derotation brace and knee function in patients with anterior cruciate ligament tears. Arthroscopy. 1985;1:264-267.

31.

Tegner Y

Pettersson G

Lysholm J

Gillquist J

. The effect of derotation braces on knee motion. Acta Orthop Scand. 1988;59:284-287.

32.

Wojtys EM

Goldstein SA

Redfern M

Trier E

Matthews LS

. A biomechanical evaluation of the Lenox Hill knee brace. Clin Orthop Relat Res. 1987;220:179-184.

33.

Wu GK

Ng GY

Mak AF

. Effects of knee bracing on the functional performance of patients with anterior cruciate ligament reconstruction. Arch Phys Med Rehabil. 2001;82:282-285.