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Bracing not recommended after ACL surgery with patellar tendon autograft
Patients who did not wear a stabilizing knee brace after surgery for isolated ACL ruptures had better single-leg hop test results than patients who wore a brace.
Researchers found no advantage of a knee brace worn for 6 weeks after isolated ACL rupture treated with patellar tendon autograft compared to when no brace was worn after the same procedure.
“Results of the current trial show no significant differences in subjective or objective assessment 4 years postoperatively of patients who wore a stabilizing knee brace for 6 weeks postoperatively and those who did not wear a brace,” Hermann O. Mayr, MD, PhD, of the department of orthopaedic and trauma surgery at Albert Ludwig University, in Freiburg, Germany, said.
“A brace after reconstruction of an isolated ACL rupture with patellar tendon autograft is not recommended for functional reasons,” he said.
Mayr and colleagues randomized 64 patients in two groups of 32 patients each. One group wore a stabilizing knee brace for 6 weeks after ACL surgery and the other group did not wear a knee brace. Investigators followed up both groups for 4 years with the International Knee Documentation Committee (IKDC) 2000 score, KT-1000 laxity test and VAS pain scores. They used radiographs to check for any osteoarthritic changes or tunnel widening in both groups.
To compare the results, the researchers used the t-test for independent and paired samples and the Pearson chi-square test. They determined a P value of <0.05 was statistically significant and used any difference in the IKDC score as the study’s endpoint, Mayr said.
The researchers completed the 4-year follow-up in 53 patients and in both groups found no significant differences in IKDC scores or instrumented anteroposterior laxity measurements obtained with the KT-1000 test, Mayr said. The subjective IKDC score was 90.5 points in the braced group and 93.2 points in the unbraced group. KT-1000 measurements were 0.6 ± 2.4 mm in the braced group and 1.8 ± 3.4 mm in the unbraced group with no significant difference.
Based on the results, the group without bracing performed better on the single-leg hop test with a 95.8% jump distance compared to a 76% jump distance in the group that wore a brace. Furthermore, the unbraced group had significantly better VAS pain scores, based on the results.
Researchers found no differences between groups when they compared the osteoarthritic changes or tunnel widening. – by Renee Blisard Buddle
- Reference:
- Mayr HO. Paper #153. Presented at: International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine Congress; May 12-16, 2013; Toronto.
- For more information:
- Hermann O. Mayr, MD, PhD, can be reached at Hugstetter Str. 55, 79106, Freiburg, Germany; email: hermann.mayr.ocm@gmx.de.
Disclosure: Mayr has no relevant financial disclosures.
Perspective
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The use of postoperative bracing following ACL reconstruction varies widely from one center to another. While some surgeons feel the graft needs protection in the early postoperative phase, others feel restoration of function quadriceps strength in particular may be compromised by wearing a brace. The current study provides some support for both views with increased laxity, albeit not statistically significant, in the non-braced group, but better hop test function in the group of patients who were braced. Overall, there was little difference between the groups, although the numbers are relatively small. This does call into question the need for routine bracing in this population. It also should be noted that this study was done using patellar tendon autograft and may not be able to be extrapolated to other types of grafts, such as hamstring autografts and allografts.