A modified cast brace: its use in nonoperative and postoperative management of serious knee ligament injuries

It has been well-proven that prolonged immobilization is detrimental to synovial joints. For the past 5 years, in an effort to minimize these undesirable sequelae, we have treated 94 patients with major knee trauma by early protected motion. Acute ligament injuries not requiring surgery were placed in the cast brace immediately, while operated cases were started about the 10th postoperative day. Our method of cast bracing stresses proper alignment of the joints, security of limb position, prevention of swelling complications, and economy of physician time. A special feature is a modified single axis joint that restricts the arc of motion to safe limits, generally 30 to 90 degrees. Functionally, our results compare quite favorably with our previous traditionally treated experience. Rehabilitation times were markedly shortened, patient acceptance was high, and complications were rare. Early motion was extremely well-tolerated with only one cast removed because of discomfort. Postoperative effusion rapidly disappeared with commencement of motion. Rapid return of motion did not correlate with a poor result, and the stability of operated knees did not loosen with time. Although lack of controls precludes definitive comparisons, we conclude that early protected motion is safe and provides significant benefits.