To Brace or Not to Brace?
Wearing a Post Op ACL brace and wearing a functional ACL brace when returning to sports can be of some debate. Many surgeons have different preferences and more recently some surgeons are leaving it up to the decision of the athlete. So what is the best choice for you?
First, please consider talking with your surgeon or physical therapist about the best option for you. Your individual case is different and it is important to discuss what is best for you and your knee with those who know you best. Remember, each injury is different and certain athletes might be restricted to a specific brace because of their injury, so always keep in mind each case can have diverse variables.
Post Op Immobilizer Braces
The immobilizer braces frequently used Post Op for ACL reconstruction are thought to project your new ACL graft while it is healing. Protecting the ACL graft after reconstructive surgery is of upmost importance because damage to the graft itself could cause it to stretch out or create issues with revascularization which helps the graft to form to your body and become living tissue.
This brace restricts range of motion and allows you to control the amount of flexion and extension of your knee using the dial gear shift as you progress through your rehabilitation. There are basically two debates regarding the immobilizer brace and not very much conclusive evidence to support either the use of the immobilizer brace or not using one. Many surgeons require use of the brace unless performing a physical therapy session and many do not.
First and foremost, many surgeons believe extensive amount of time in an immobilizer brace can contribute to extra muscle atrophy and loss of function and proprioceptive abilities. Basically this means your leg will rely on the brace for support instead of the muscles and tendons surrounding the knee. But this is also a safety issue because following ACL reconstruction the extensor muscles like the quadriceps aren’t strong enough to support your leg for a number of days or weeks. Because of these reasons many surgeons prefer use of the immobilizer brace for extra assistance in the first few weeks after ACL reconstruction surgery. Few studies have been conducted comparing the effectiveness of a Post Op Immobilizer but in 2007, Wright and Fetzer performed a systematic review of 12 level 1 randomized controlled trials and found no evidence that braces contribute to pain control, graft stability, ROM, or protection from additional injury. The remaining authors also concluded in their respective reviews that the literature shows no added benefit from bracing in the postoperative period. 1 In conclusion, Post Op immobilizers do have many benefits but are not a necessity. Consult with your doctor on a treatment program best for you and design a plan of action to either use the brace safely and minimally, or implement a safety plan to go without the immobilizer brace.
Functional braces are typically used for athletes returning to sport. They can be custom fit or bought at a store off of the shelf. The purpose of the brace is to protect the knees from further ACL injury by restricting the forces applied to the knee joint specifically in anterior translation. Studies show functional brace use does not improve long term patient outcomes following ACL reconstruction but it has proven to reduce subsequent injury rates while skiing in both ACL deficient and ACL reconstructed skiers. It is important to remember no brace can replicate the force flexion behavior from your native ACL. Biomechanical and clinical evidence suggests current functional bracing technologies do not sufficiently restore normal biomechanics to the ACL-deficient knee, protect the reconstructed ACL, and improve long-term patient outcomes. 2
Sometimes the effectiveness of the brace is merely psychological. Some studies have proved the benefits of psychological advantages of bracing the knee post operatively, but again there are no definitive conclusions as to how helpful a functional brace can be at eliminating and preventing re-injury to the ACL. Until further studies are conducted, it is your choice to make. Consult with your doctor and physical therapist regarding your goals. Make sure you perform rehabilitation and strength training exercises without the brace to ensure proper muscle control and proprioceptive awareness. If you feel comfortable without the brace on the field or court then go for it. If you prefer to use a brace, that’s fine too. The choice is yours.
- Anderson, Browning, Urband, Kluczynski, Bisson. A Systematic Summary of Systematic Reviews on the topic of the Anterior Cruciate Ligament. Orthop J Sports Med 2016 Mar 15, 4 (3): 2325967116634074
- Smith, Laprade, Jansson, Aroen, Wijdicks. Functional bracing of ACL injuries: current state and future directions. Knee Surg Sports Traumatol Arthrsoc. 2014 May, 22(5):1131-41