The effectiveness of knee bracing in non-operative soft tissue and degenerative knee injuries: A systematic review

Soft tissue and degenerative knee injuries, including anterior/posterior cruciate ligament (ACL/PCL) injuries, medial knee osteoarthritis (MKOA), and patellofemoral osteoarthritis (PFOA), are common causes of pain and functional decline. Knee bracing is often used as part of non-operative treatment, but its clinical effectiveness remains uncertain. This systematic review aimed to evaluate the role of bracing in improving pain, function, and preventing surgical conversion in adults with non-operatively managed knee injuries.

A systematic review was conducted following PRISMA guidelines. Embase, Ovid MEDLINE, and Ovid Emcare were searched from inception to March 2025. Studies were included if they reported clinical outcomes of knee bracing in adults with soft tissue or degenerative knee injuries treated non-operatively. Studies focused on biomechanics, prophylaxis, surgery, or paediatric populations were excluded. Data were synthesised narratively with weighted summary statistics.

Seventeen studies (706 patients) were included: six on ACL injuries, three PCL, three MKOA, and five PFOA. MKOA studies showed pooled improvements of +14.6 in KOOS Pain and -1.9 in VAS (SDs 1.0 and 0.5). ACL studies reported a pooled Lysholm gain of +11.8 (SD = 4.3), while PCL outcomes showed large single-study improvements (KOOS Pain +31.0, IKDC + 30.0). WOMAC scores improved in MKOA (-13.7) but declined in PFOA (-6.4). Failure (surgical conversion) was reported in 13 studies, with the highest rates in PCL (16.4%) and ACL (10.6%), and the lowest in MKOA (0%) and PFOA (4.0%). Complications were infrequently reported; skin irritation was the most common adverse event.

Knee bracing demonstrated the most consistent pain and functional improvements in degenerative and PCL injuries. In contrast, outcomes in ACL injuries were more variable and associated with higher failure rates, underscoring the need for injury-specific bracing strategies. These findings emphasise the importance of patient selection, brace design, and early intervention, and support the need for higher-quality studies to guide non-operative management strategies.

Level IV.