Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review

The purpose of this study was to evaluate the current literature on the use of functional knee braces after anterior cruciate ligament (ACL) reconstruction with respect to clinical and in vivo biomechanical data.

A systematic search of both the PubMed and Embase databases was performed to identify all studies that reported clinical and/or in vivo biomechanical results of functional bracing versus nonbracing after ACL reconstruction. Extracted data included study design, surgical reconstruction techniques, postoperative rehabilitation protocols, objective outcomes, and subjective outcomes scores. The in vivo biomechanical data collected included kinematics, strength, function, and proprioception. Subjective clinical outcomes scores were collected when available. Quality appraisal analyses were performed using the Cochrane Collaboration tools for randomized and nonrandomized trials to aid in data interpretation.

Fifteen studies met the selection criteria (including 3 randomized trials [level II], 11 nonrandomized trials [level II], and 1 retrospective comparative study [level III]), with follow-up intervals ranging from 3 to 48 months. Most studies were designed to compare the effects of functional bracing versus nonbracing on subjective and objective results in patients who underwent previous primary ACL reconstruction. Functional bracing significantly improved kinematics of the knee joint and improved gait kinetics, although functional bracing may decrease quadriceps activation without affecting functional tests, range of motion, and proprioception. Four studies reported no differences in subjective outcomes scores with brace use; however, one study reported increased patient confidence with brace use, whereas another study reported decreased pain and quicker return to work when the brace was not used.

The effectiveness of postoperative functional bracing following ACL reconstruction remains elusive. Some data suggest that functional bracing may have some benefit with regard to in vivo knee kinematics and may offer increased protection of the implanted graft after ACL reconstruction without sacrificing function, range of motion, or proprioception. However, limited evidence exists supporting the use of routine functional bracing to decrease the rate of reinjury after ACL reconstruction.