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Biomechanical effects of functional knee bracing. Practical implications

J C Vailas¹, M Pink

¹New Hampshire Musculoskeletal Institute, Manchester.

Sports Medicine (Auckland, N.Z.)

|March 1, 1993

Summary

Anterior cruciate ligament knee bracing effectiveness is debated. While shell braces offer more stability than strap braces, their true clinical benefit for anterior tibial translation remains unclear, suggesting a role in comprehensive rehabilitation.

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Area of Science:

Orthopedic Biomechanics
Sports Medicine
Rehabilitation Engineering

Background:

The efficacy of bracing for anterior cruciate ligament (ACL)-deficient knees is a subject of ongoing clinical debate.
Existing literature provides observational data on brace performance, guiding clinical practice in the absence of definitive evidence.
Brace design, particularly the distinction between shell-type and strap-type braces, influences knee stability.

Purpose of the Study:

To synthesize current knowledge on the functional aspects and clinical utility of knee braces for anterior cruciate ligament deficiency.
To compare the stability and performance characteristics of different brace designs, including shell and strap types.
To evaluate the role of bracing within a broader rehabilitation framework for athletes with ACL deficiency.

Main Methods:

Systematic review and critical analysis of published literature on anterior cruciate ligament knee bracing.
Comparison of brace designs based on reported stability, fit, and patient-reported outcomes.
Evaluation of biomechanical data from static bench testing and in-vivo kinematic/force plate analyses.

Main Results:

Shell-type braces generally offer greater knee stability compared to strap-type braces.
Hinge placement is more critical for brace performance (reducing pistoning) than the brace type itself.
Static testing indicates limited efficacy against anterior tibial translation during athletic forces, though kinematic data suggest broader lower extremity mechanical effects.

Conclusions:

Custom-fitted braces offer superior fit but may be more restrictive than off-the-shelf options.
Despite bench-testing limitations, functional bracing may provide a mechanical advantage to the lower extremity.
Functional bracing is recommended as an adjunct to comprehensive rehabilitation programs for athletes with significant functional deficits due to ACL deficiency.