To​ ​Brace​ ​or​ ​Not​ ​To​ ​Brace​ ​an

ACL​ ​Tear​ ​Post​ ​Surgically

Research​ ​Team
Catherine​ ​Martin,​ ​Haley​ ​Banks,​ ​Lani​ ​Rinehardt,​ ​ATS
Chaypin​ ​Buchanan,​ ​AT​ ​Advisor
Dennis​ ​Cobler,Faculty​ ​Advisor
Scott​ ​Rinehardt,​ ​Content​ ​Advisor​ ​in​ ​Physical​ ​Therapy

11/30/2017

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 Table​ ​of​ ​Contents
CLINICAL​ ​SCENARIO...​ ​3
Focused​ ​Clinical​ ​Question...​ ​3
Keywords...4
SUMMARY​ ​OF​ ​SEARCH​ ​METHODOLOGY...4
Search​ ​Strategy...4
Sources​ ​of​ ​Evidence​ ​Searched...4
Best​ ​Evidence​ ​Reviewed...5
CLINICAL​ ​BOTTOM​ ​LINE...6
Implications​ ​for​ ​Clinical​ ​Practice...7
Recommendations​ ​for​ ​Future​ ​Research...7
REFERENCES...​ ​8

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CLINICAL​ ​SCENARIO
The​ ​problem​ ​arises​ ​when​ ​an​ ​athlete​ ​returns​ ​to​ ​play​ ​and​ ​whether​ ​best​ ​practice​ ​is​ ​to​ ​wear​ ​an​ ​ACL
brace​ ​or​ ​to​ ​not​ ​wear​ ​a​ ​brace​ ​following​ ​post​ ​ACL​ ​tear​ ​surgery.​ ​The​ ​amount​ ​of​ ​ACL​ ​injuries​ ​on​ ​the
women’s​ ​soccer​ ​team​ ​at​ ​Emory​ ​&​ ​Henry​ ​College​ ​made​ ​us​ ​question​ ​which​ ​is​ ​better.

Development​ ​of​ ​Clinical​ ​Question:

We​ ​had​ ​started​ ​with​ ​a​ ​brainstorming​ ​session​ ​with​ ​a​ ​certified​ ​athletic​ ​trainer​ ​to​ ​help​ ​us​ ​narrow
down​ ​our​ ​thoughts.​ ​We​ ​began​ ​with​ ​braces​ ​in​ ​general​ ​and​ ​whether​ ​or​ ​not​ ​they​ ​are​ ​beneficial​ ​to
athletes.​ ​The​ ​certified​ ​athletic​ ​trainer​ ​brought​ ​up​ ​the​ ​fact​ ​that​ ​there​ ​were​ ​three​ ​post​ ​surgical​ ​ACL
tear​ ​athletes​ ​on​ ​one​ ​team​ ​that​ ​she​ ​has​ ​been​ ​working​ ​with.​ ​So​ ​our​ ​question​ ​became​ ​more
specific​ ​because​ ​of​ ​the​ ​fact​ ​that​ ​we​ ​had​ ​three​ ​athletes​ ​to​ ​speak​ ​with​ ​about​ ​their​ ​personal
opinions​ ​of​ ​wearing​ ​or​ ​not​ ​wearing​ ​a​ ​brace,​ ​whether​ ​they​ ​feel​ ​it​ ​inhibits​ ​their​ ​play​ ​or​ ​not,​ ​and
how​ ​it​ ​makes​ ​them​ ​feel.

Development​ ​of​ ​Investigation​ ​Committee:

● Chaypin​ ​Buchanan-​ ​She​ ​is​ ​the​ ​designated​ ​athletic​ ​trainer​ ​for​ ​the​ ​E&H​ ​Women’s​ ​soccer
team.​ ​With​ ​three​ ​ACL​ ​tears​ ​within​ ​a​ ​month​ ​of​ ​each​ ​other​ ​this​ ​team​ ​had​ ​a​ ​good​ ​variety​ ​of
players​ ​who​ ​either​ ​wore​ ​an​ ​ACL​ ​brace​ ​or​ ​chose​ ​to​ ​not​ ​wear​ ​one.
● Dennis​ ​Cobler-​ ​Dr.Cobler​ ​is​ ​the​ ​head​ ​of​ ​the​ ​athletic​ ​training​ ​program​ ​as​ ​well​ ​as​ ​a
certified​ ​athletic​ ​trainer.​ ​We​ ​decided​ ​to​ ​select​ ​him​ ​based​ ​on​ ​his​ ​experience​ ​in​ ​the​ ​field​ ​as
well​ ​as​ ​an​ ​AT’s​ ​opinion​ ​vs.​ ​a​ ​PT’s​ ​opinion​ ​on​ ​whether​ ​or​ ​not​ ​to​ ​wear​ ​an​ ​ACL​ ​brace​ ​post
surgery.
● Scott​ ​Rinehardt-​ ​Dr.​ ​Rinehardt​ ​is​ ​a​ ​certified​ ​physical​ ​therapist​ ​with​ ​a​ ​slight​ ​background​ ​in
athletic​ ​training.​ ​Throughout​ ​his​ ​career​ ​in​ ​the​ ​medical​ ​field​ ​he​ ​has​ ​seen​ ​more​ ​than​ ​a
handful​ ​of​ ​ACL​ ​tears.​ ​He​ ​was​ ​selected​ ​as​ ​our​ ​content​ ​expert​ ​based​ ​on​ ​both​ ​his
experience​ ​as​ ​well​ ​as​ ​a​ ​PT’s​ ​opinion​ ​vs.​ ​an​ ​AT’s​ ​opinion​ ​on​ ​to​ ​wear​ ​an​ ​ACL​ ​brace​ ​post
surgery.

Focused​ ​Clinical​ ​Question:

In​ ​ACL​ ​tear​ ​post​ ​surgery​ ​patients,​ ​what​ ​is​ ​the​ ​effects​ ​of​ ​return​ ​to​ ​play​ ​with​ ​a​ ​brace​ ​compared​ ​to
effects​ ​of​ ​return​ ​to​ ​play​ ​without​ ​a​ ​brace​ ​as​ ​it​ ​pertains​ ​to​ ​ROM,​ ​patient​ ​confidence,​ ​and​ ​comfort?

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Keywords:
We​ ​used​ ​the​ ​words​ ​benefits,​ ​cons,​ ​comfort,​ ​acl​ ​brace,​ ​and​ ​range​ ​of​ ​motion​ ​along​ ​with​ ​the
phrase​ ​acl​ ​brace.

SUMMARY​ ​OF​ ​SEARCH​ ​METHODOLOGY

We​ ​tried​ ​to​ ​generalize​ ​our​ ​topic​ ​to​ ​start​ ​our​ ​research.​ ​We​ ​started​ ​with​ ​searching​ ​ACL​ ​brace
benefits​ ​to​ ​get​ ​a​ ​general​ ​article​ ​of​ ​research​ ​to​ ​see​ ​why​ ​clinicians​ ​choose​ ​to​ ​have​ ​patients​ ​wear​ ​a
brace​ ​when​ ​returning​ ​to​ ​play.​ ​We​ ​then​ ​input​ ​the​ ​negatives​ ​of​ ​wearing​ ​a​ ​brace​ ​for​ ​return​ ​to​ ​play.
We​ ​found​ ​that​ ​most​ ​of​ ​that​ ​research​ ​came​ ​from​ ​patient​ ​comfort,​ ​confidence,​ ​and​ ​range​ ​of
motion​ ​or​ ​the​ ​feeling​ ​of​ ​being​ ​restricted.​ ​We​ ​also​ ​read​ ​that​ ​some​ ​clinicians​ ​use​ ​the​ ​brace​ ​to​ ​help
with​ ​immobilization​ ​of​ ​the​ ​knee​ ​following​ ​surgery​ ​and​ ​then​ ​work​ ​on​ ​range​ ​of​ ​motion​ ​properly
without​ ​the​ ​brace​ ​so​ ​the​ ​athlete​ ​does​ ​not​ ​rely​ ​solely​ ​on​ ​the​ ​brace​ ​itself​ ​rather​ ​than​ ​their
reconstructed​ ​ACL.​ ​Our​ ​committee​ ​came​ ​in​ ​when​ ​asking​ ​opinions​ ​of​ ​what​ ​they​ ​would​ ​use​ ​in​ ​the
clinical​ ​setting.​ ​Dr.​ ​Scott​ ​Rinehardt​ ​believed​ ​in​ ​the​ ​brace​ ​as​ ​it​ ​would​ ​protect​ ​the​ ​ACL​ ​from
stretching​ ​to​ ​far​ ​to​ ​avoid​ ​injury​ ​again.​ ​Chaypin​ ​Buchanan,​ ​the​ ​certified​ ​athletic​ ​trainer,​ ​told​ ​us
that​ ​going​ ​with​ ​a​ ​brace​ ​for​ ​return​ ​to​ ​play​ ​is​ ​safe​ ​and​ ​ultimately​ ​is​ ​the​ ​athlete’s​ ​preference.​ ​Two​ ​of
the​ ​three​ ​athletes​ ​on​ ​the​ ​women’s​ ​soccer​ ​team​ ​came​ ​back​ ​with​ ​braces,​ ​while​ ​one​ ​did​ ​not
because​ ​of​ ​her​ ​comfort,​ ​her​ ​confidence,​ ​and​ ​her​ ​feeling​ ​like​ ​it​ ​was​ ​holding​ ​her​ ​back.​ ​Dennis
Cobler​ ​stated​ ​that​ ​wearing​ ​a​ ​brace​ ​in​ ​the​ ​beginning​ ​of​ ​rehabilitation​ ​and​ ​up​ ​to​ ​a​ ​year​ ​is​ ​good​ ​for
keeping​ ​the​ ​knee​ ​from​ ​extending​ ​and​ ​flexing​ ​too​ ​much​ ​but​ ​after​ ​that​ ​the​ ​brace​ ​should​ ​not​ ​be
used​ ​to​ ​make​ ​sure​ ​the​ ​patient​ ​does​ ​not​ ​become​ ​reliant​ ​on​ ​the​ ​brace​ ​itself​ ​rather​ ​than​ ​trusting
the​ ​reconstruction​ ​surgery.

Search​ ​Strategy:
We​ ​used​ ​PICO​ ​to​ ​format​ ​our​ ​clinical​ ​question.​ ​P​ ​is​ ​patient​ ​population​ ​or​ ​clinical​ ​problem​ ​and​ ​our
patient​ ​population​ ​is​ ​post​ ​surgical​ ​ACL​ ​tear​ ​patients​ ​and​ ​the​ ​clinical​ ​problem​ ​is​ ​whether​ ​to​ ​wear
a​ ​brace​ ​at​ ​the​ ​return​ ​to​ ​play​ ​stage​ ​or​ ​not,​ ​depending​ ​on​ ​comfort,​ ​confidence,​ ​and​ ​range​ ​of
motion.​ ​I​ ​is​ ​the​ ​intervention​ ​of​ ​interest​ ​and​ ​ours​ ​is​ ​the​ ​amount​ ​of​ ​ACL​ ​tears​ ​on​ ​the​ ​women’s
soccer​ ​team​ ​and​ ​how​ ​they​ ​personally​ ​feel​ ​about​ ​wearing​ ​a​ ​brace​ ​or​ ​not​ ​wearing​ ​a​ ​brace.​ ​C​ ​is
comparison​ ​of​ ​interventions​ ​and​ ​ours​ ​in​ ​comparing​ ​brace​ ​range​ ​of​ ​motion,​ ​comfort,​ ​and
confidence​ ​to​ ​not​ ​wear​ ​a​ ​brace​ ​with​ ​confidence,​ ​comfort,​ ​and​ ​range​ ​of​ ​motion.​ ​O​ ​is​ ​outcome​ ​of
interest​ ​and​ ​our​ ​outcome​ ​is​ ​that​ ​many​ ​do​ ​not​ ​wear​ ​braces​ ​because​ ​of​ ​the​ ​fact​ ​of​ ​their​ ​personal
confidence​ ​and​ ​comfort​ ​and​ ​sometimes​ ​their​ ​range​ ​of​ ​motion​ ​is​ ​not​ ​where​ ​it​ ​should​ ​be.

Sources​ ​of​ ​Evidence​ ​Searched:

Medline​ ​Complete,​ ​Academic​ ​Search​ ​Complete

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Best​ ​Evidence​ ​Reviewed:

1. Effects​ ​of​ ​a​ ​Knee​ ​Extension​ ​Constraint​ ​Brace​ ​on​ ​Lower​ ​Extremity​ ​Movements
after​ ​ACL​ ​Reconstruction,​ ​Christopher​ ​J.​ ​Stanley,​ ​Michael​ ​T.​ ​Gross,​ ​William​ ​E.
Garrett:​ ​“​As​ ​many​ ​as​ ​100,000​ ​to​ ​250,000​ ​people​ ​in​ ​the​ ​United​ ​States​ ​have​ ​an
ACL​ ​injury​ ​each​ ​year.”​ ​ ​A​ ​knee​ ​extension​ ​brace​ ​was​ ​designed​ ​and​ ​meant​ ​to​ ​be
as​ ​effective​ ​in​ ​increasing​ ​knee​ ​flexion​ ​and​ ​decreasing​ ​peak​ ​posterior​ ​ground
reaction​ ​force​ ​for​ ​subjects​ ​without​ ​lower​ ​extremity​ ​injuries​ ​during​ ​the​ ​landing​ ​of​ ​a
stop-jump​ ​task.​ ​Increasing​ ​knee​ ​flexion​ ​and​ ​decreasing​ ​peak​ ​posterior​ ​ground
reaction​ ​force​ ​during​ ​landing​ ​may​ ​reduce​ ​the​ ​risk​ ​for​ ​noncontact​ ​ACL​ ​injuries.​ ​It
was​ ​determined​ ​the​ ​effects​ ​of​ ​a​ ​knee​ ​extension​ ​constraint​ ​brace​ ​on​ ​knee​ ​flexion
angle,​ ​peak​ ​posterior​ ​ground​ ​reaction​ ​force,​ ​and​ ​movement​ ​speed​ ​in​ ​functional
activities​ ​of​ ​patients​ ​after​ ​ACL​ ​reconstruction​ ​in​ ​sagittal​ ​plane.​ ​Knee​ ​flexion​ ​was
greater​ ​when​ ​wearing​ ​the​ ​brace​ ​rather​ ​than​ ​not​ ​wearing​ ​a​ ​brace.​ ​Movement
speed​ ​was​ ​lower​ ​when​ ​wearing​ ​the​ ​brace​ ​than​ ​wearing​ ​no​ ​brace​ ​with​ ​walking.
Peak​ ​posterior​ ​ground​ ​reaction​ ​force​ ​was​ ​lower​ ​when​ ​wearing​ ​the​ ​brace​ ​than
when​ ​wearing​ ​a​ ​non​ ​constraint​ ​brace​ ​and​ ​no​ ​brace.
2. Does​ ​Wearing​ ​a​ ​Functional​ ​Knee​ ​Brace​ ​Affect​ ​Hamstring​ ​Reflex​ ​Time​ ​in
Subjects​ ​with​ ​Anterior​ ​Cruciate​ ​Ligament​ ​Deficiency​ ​During​ ​Muscle​ ​Fatigue?,
Rita​ ​Y.​ ​Lam:​ ​It​ ​was​ ​found​ ​that​ ​the​ ​timing​ ​of​ ​knee​ ​muscle​ ​contraction​ ​during
walking​ ​for​ ​subjects​ ​with​ ​ACL​ ​deficiency​ ​is​ ​different​ ​from​ ​with​ ​intact​ ​ACL​ ​timing​ ​of
the​ ​knee​ ​muscle​ ​contraction.​ ​“Functional​ ​knee​ ​braces​ ​are​ ​commonly​ ​used​ ​by
people​ ​with​ ​ACL​ ​deficiency​ ​or​ ​after​ ​surgical​ ​reconstruction​ ​of​ ​the​ ​ACL.”​ ​Braces
can​ ​provide​ ​protection​ ​to​ ​the​ ​knee​ ​under​ ​low-loading​ ​conditions​ ​(walking)​ ​but​ ​not
under​ ​high-loading​ ​conditions​ ​(sports,​ ​running,​ ​jumping,​ ​etc.).​ ​“Most​ ​subjects
wearing​ ​knee​ ​braces​ ​report​ ​that​ ​the​ ​stability​ ​of​ ​their​ ​knee​ ​joints​ ​is​ ​improved
during​ ​activities​ ​like​ ​single-leg​ ​hopping​ ​and​ ​shuttle​ ​running.”​ ​As​ ​a​ ​protagonist​ ​for
ACL,​ ​the​ ​hamstring​ ​muscle​ ​group​ ​provides​ ​anterior​ ​restraint​ ​to​ ​the​ ​unstable​ ​knee
in​ ​patients​ ​with​ ​ACL​ ​deficiency.​ ​In​ ​this​ ​study,​ ​hamstring​ ​reflex​ ​was​ ​facilitated​ ​in​ ​a
brace,​ ​which​ ​allows​ ​a​ ​better​ ​protective​ ​mechanism​ ​with​ ​the​ ​bracing.
Rehabilitation​ ​programs​ ​must​ ​be​ ​planned​ ​to​ ​improve​ ​the​ ​endurance​ ​of​ ​the​ ​knee
musculature,​ ​and​ ​people​ ​should​ ​be​ ​more​ ​driven​ ​or​ ​determined​ ​with​ ​their​ ​actions
when​ ​muscle​ ​fatigue​ ​has​ ​developed​ ​during​ ​sports.​ ​“Subjects​ ​with​ ​ACL​ ​deficiency
should​ ​not​ ​be​ ​dependent​ ​on​ ​the​ ​functional​ ​knee​ ​brace​ ​for​ ​hamstring​ ​facilitation
during​ ​prolonged​ ​sporting​ ​activities​ ​when​ ​muscle​ ​is​ ​fatigued.”
3. Does​ ​a​ ​Knee​ ​Brace​ ​Decrease​ ​Recurrent​ ​ACL​ ​Surgery?​ ​,​ ​James​ ​L.​ ​Lord:​ ​Based
through​ ​random​ ​trials,​ ​post​ ​ACL​ ​reconstruction,​ ​a​ ​brace​ ​does​ ​not​ ​protect​ ​against
re-injury.​ ​In​ ​a​ ​study​ ​using​ ​62​ ​patients,​ ​ ​they​ ​found​ ​no​ ​benefit​ ​from​ ​the​ ​brace​ ​at

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 any​ ​stage​ ​in​ ​their​ ​recovery​ ​including​ ​at​ ​the​ ​2​ ​year​ ​follow​ ​up.​ ​They​ ​also​ ​did
another​ ​study​ ​where​ ​they​ ​used​ ​60​ ​patients​ ​in​ ​total,​ ​30​ ​using​ ​a​ ​brace​ ​and​ ​30
without.​ ​They​ ​evaluated​ ​their​ ​running,​ ​jumping,​ ​and​ ​turning​ ​performance.​ ​The
study​ ​showed​ ​that​ ​the​ ​patients​ ​that​ ​did​ ​not​ ​wear​ ​a​ ​brace​ ​showed​ ​significantly
better​ ​performance​ ​while​ ​the​ ​patients​ ​that​ ​wore​ ​the​ ​brace​ ​stated​ ​that​ ​they​ ​felt
more​ ​confident​ ​with​ ​the​ ​brace​ ​and​ ​though​ ​it​ ​helped​ ​even​ ​though​ ​the​ ​statistics
didn’t​ ​show​ ​it.​ ​AAOS​ ​says​ ​that​ ​rehabilitation​ ​braces​ ​are​ ​effective​ ​for​ ​preventing
too​ ​much​ ​flexion​ ​and​ ​extension.​ ​However​ ​says​ ​that​ ​functional​ ​braces​ ​do​ ​not
restore​ ​stability​ ​under​ ​athletic​ ​activity.​ ​AAP​ ​says​ ​that​ ​a​ ​brace​ ​will​ ​help​ ​prevent
further​ ​injury​ ​as​ ​long​ ​as​ ​the​ ​brace​ ​isn’t​ ​used​ ​as​ ​a​ ​substitute​ ​for​ ​rehab.​ ​They​ ​went
on​ ​to​ ​say​ ​that​ ​they​ ​would​ ​let​ ​them​ ​use​ ​a​ ​brace​ ​depending​ ​on​ ​the​ ​patient​ ​to
provide​ ​more​ ​a​ ​mental​ ​comfort.
4. Knee​ ​Bracing​ ​After​ ​ACL​ ​Reconstruction:​ ​Effects​ ​on​ ​Postural​ ​Control
Proprioception,​ ​Trevor​ ​B.​ ​Birmingham,​ ​John​ ​F.​ ​Kramer,​ ​Alexandra​ ​Kirkley,​ ​J.
Timothy​ ​Inglis,​ ​Sandy​ ​J.​ ​Spaulding,​ ​and​ ​Anthony​ ​A.​ ​Vandervoort:​ ​They
performed​ ​a​ ​study​ ​with​ ​30​ ​patients​ ​doing​ ​high​ ​intensity​ ​activity​ ​for​ ​90​ ​minutes
and​ ​recording​ ​how​ ​well​ ​their​ ​performance​ ​was​ ​and​ ​if​ ​there​ ​was​ ​any​ ​difficulty​ ​or
complaints.​ ​They​ ​also​ ​had​ ​the​ ​patients​ ​do​ ​different​ ​movements​ ​such​ ​as​ ​90
degree​ ​knee​ ​flexion,​ ​hop​ ​test,​ ​and​ ​hop​ ​test​ ​with​ ​distance​ ​jump.​ ​The​ ​result
between​ ​brace​ ​or​ ​no​ ​brace​ ​were​ ​not​ ​substantially​ ​different​ ​including​ ​when​ ​they
repeated​ ​the​ ​experiment​ ​with​ ​different​ ​patients.​ ​However​ ​the​ ​functional​ ​brace
showed​ ​only​ ​minor​ ​improvements.
5. Study​ ​on​ ​Three-Dimensional​ ​Kinematics​ ​and​ ​Electromyography​ ​of​ ​ACL​ ​Deficient
Knee​ ​Participants​ ​Wearing​ ​a​ ​Functional​ ​Knee​ ​Brace​ ​During​ ​Running,​ ​D.​ ​Theoret:
The​ ​study​ ​consisted​ ​of​ ​11​ ​male​ ​participants​ ​for​ ​10​ ​consecutive​ ​gait​ ​cycles​ ​during
running​ ​while​ ​wearing​ ​a​ ​brace.​ ​They​ ​used​ ​only​ ​male​ ​subjects​ ​in​ ​the​ ​study​ ​so​ ​that
the​ ​autonomic​ ​and​ ​biomechanical​ ​differences​ ​didn’t​ ​become​ ​a​ ​factor.​ ​They​ ​set​ ​up
four​ ​high​ ​speed​ ​digitial​ ​cameras​ ​to​ ​record​ ​the​ ​injured​ ​knee​ ​and​ ​set​ ​to​ ​where​ ​it
was​ ​zoomed​ ​in​ ​only​ ​on​ ​the​ ​ACL.​ ​The​ ​altitudes​ ​at​ ​heel​ ​strike​ ​and​ ​the​ ​area​ ​under
curves​ ​were​ ​obtained​ ​and​ ​compared​ ​and​ ​used​ ​to​ ​record​ ​the​ ​onset​ ​of​ ​muscle
contractions​ ​for​ ​the​ ​running​ ​cycle.​ ​ ​It​ ​showed​ ​that​ ​bracing​ ​significantly​ ​reduced
total​ ​range​ ​of​ ​motion​ ​in​ ​the​ ​frontal​ ​and​ ​transverse​ ​planes​ ​as​ ​well​ ​as​ ​some​ ​in​ ​the
sagittal.
6. Can​ ​a​ ​post-operative​ ​brace​ ​in​ ​slight​ ​hyperextension​ ​prevent​ ​extension​ ​deficit
after​ ​anterior​ ​cruciate​ ​ligament​ ​reconstruction?,​ ​Mikkelson,​ ​C:​​ ​A​ ​randomized
study​ ​observed​ ​that​ ​post-operative​ ​ACL​ ​braces​ ​along​ ​with​ ​post-operative
bandages​ ​do​ ​not​ ​allow​ ​the​ ​patient​ ​to​ ​reach​ ​full​ ​extension.​ ​In​ ​the​ ​first​ ​experiment
ten​ ​uninjured​ ​knees​ ​with​ ​a​ ​known​ ​hyperextension​ ​were​ ​bandaged​ ​the​ ​same​ ​way
as​ ​it​ ​would​ ​be​ ​after​ ​an​ ​ACL-reconstruction.​ ​Following​ ​that​ ​the​ ​knees​ ​were​ ​then

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 placed​ ​in​ ​a​ ​Hypex​ ​brace​ ​set​ ​at​ ​0​ ​degrees,​ ​-5​ ​degrees,​ ​and​ ​-10​ ​degrees​ ​of​ ​knee
extension.​ ​The​ ​results​ ​were​ ​that​ ​not​ ​a​ ​single​ ​knee​ ​was​ ​found​ ​to​ ​be​ ​straight​ ​at​ ​0
degrees​ ​but​ ​at​ ​-5​ ​degrees​ ​most​ ​were​ ​straight​ ​or​ ​in​ ​slight​ ​hyperextension.​ ​The
second​ ​experiment​ ​consisted​ ​of​ ​44​ ​randomized​ ​patients​ ​who​ ​underwent
ACL-reconstruction​ ​with​ ​a​ ​bone​ ​patellar​ ​tendon​ ​bone​ ​graft.​ ​Each​ ​patient​ ​was
randomised​ ​to​ ​use​ ​either​ ​a​ ​brace​ ​set​ ​at​ ​-5​ ​degree​ ​or​ ​0​ ​degree​ ​for​ ​the​ ​first​ ​3
weeks​ ​post​ ​operation.​ ​After​ ​3​ ​months​ ​had​ ​passed​ ​ROM​ ​was​ ​determined​ ​using​ ​a
goniometer.​ ​After​ ​three​ ​months​ ​2/22​ ​patients​ ​with​ ​the​ ​brace​ ​at​ ​-5​ ​degree​ ​and
12/22​ ​with​ ​it​ ​set​ ​at​ ​0​ ​degree​ ​had​ ​loss​ ​of​ ​full​ ​extension​ ​of​ ​2​ ​degree​ ​or​ ​more.
Therefore​ ​it​ ​was​ ​concluded​ ​that​ ​a​ ​ACL​ ​brace​ ​set​ ​at​ ​-5​ ​degree​ ​seems​ ​to​ ​be​ ​the
easiest​ ​way​ ​of​ ​ensuring​ ​full​ ​knee​ ​extension.
7. Brace​ ​or​ ​no-brace​ ​after​ ​ACL​ ​graft?,​ ​Mayr,​ ​H:​ ​A​ ​randomized​ ​study​ ​was​ ​conducted
including​ ​64​ ​patients​ ​who​ ​needed​ ​ACL-reconstruction.​ ​The​ ​patients​ ​were​ ​divided
into​ ​two​ ​groups​ ​and​ ​treated​ ​with​ ​or​ ​without​ ​a​ ​stabilizing​ ​knee​ ​brace​ ​for​ ​6​ ​weeks
post-operation.​ ​A​ ​follow-up​ ​examine​ ​was​ ​conducted​ ​4​ ​years​ ​after​ ​operation
comprised​ ​IKDC​ ​2000,​ ​KT1000​ ​measurement,​ ​a​ ​visual​ ​analogue​ ​pain​ ​scale​ ​and
radiographic​ ​evaluation.​ ​Based​ ​on​ ​the​ ​results​ ​from​ ​the​ ​testing​ ​it​ ​shows​ ​that​ ​there
is​ ​no​ ​advantage​ ​to​ ​wearing​ ​an​ ​ACL​ ​brace​ ​as​ ​opposed​ ​to​ ​not​ ​wearing​ ​one​ ​at
4-year​ ​follow-up​ ​appointments.​ ​It​ ​is​ ​actually​ ​stated​ ​that​ ​wearing​ ​a​ ​knee-stabilizing
brace​ ​after​ ​ACL​ ​reconstruction​ ​with​ ​autologous​ ​patellar​ ​tendon​ ​graft​ ​is​ ​not
recommended.

CLINICAL​ ​BOTTOM​ ​LINE

Based​ ​on​ ​our​ ​research,​ ​we​ ​have​ ​found​ ​that​ ​there​ ​is​ ​no​ ​definite​ ​answer​ ​to​ ​our​ ​question.​ ​Our
articles​ ​had​ ​multiple​ ​studies​ ​done​ ​as​ ​whether​ ​or​ ​not​ ​it​ ​was​ ​better​ ​to​ ​wear​ ​a​ ​brace​ ​after​ ​ACL
surgery​ ​or​ ​not.​ ​Most​ ​of​ ​the​ ​articles​ ​said​ ​that​ ​there​ ​was​ ​no​ ​significant​ ​difference​ ​in​ ​the​ ​result
during​ ​high​ ​performance​ ​activity​ ​and​ ​showed​ ​no​ ​signs​ ​of​ ​improved​ ​stability.​ ​The​ ​main
difference,​ ​if​ ​any​ ​occurred​ ​was​ ​due​ ​to​ ​what​ ​the​ ​patient​ ​felt​ ​more​ ​comfortable​ ​in.​ ​Many​ ​patients
stated​ ​that​ ​they​ ​felt​ ​they​ ​could​ ​do​ ​more​ ​with​ ​the​ ​brace​ ​rather​ ​than​ ​without.​ ​So​ ​basically,
depending​ ​on​ ​the​ ​patient​ ​and​ ​their​ ​performance​ ​confidence​ ​depends​ ​on​ ​whether​ ​wearing​ ​a
brace​ ​after​ ​ACL​ ​reconstruction​ ​would​ ​be​ ​the​ ​best​ ​option.

​ ​Implications​ ​for​ ​Clinical​ ​Practice

Our​ ​question​ ​and​ ​evidence​ ​does​ ​not​ ​get​ ​a​ ​specific​ ​or​ ​set​ ​in​ ​stone​ ​answer​ ​on​ ​what​ ​should​ ​be
done.​ ​Patient​ ​to​ ​patient​ ​is​ ​different​ ​every​ ​time​ ​and​ ​there​ ​is​ ​not​ ​a​ ​textbook​ ​answer​ ​on​ ​what
should​ ​be​ ​done.​ ​We​ ​found​ ​that​ ​most​ ​of​ ​the​ ​time,​ ​the​ ​patient’s​ ​doctor​ ​tells​ ​them​ ​to​ ​wear​ ​the

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brace​ ​indefinitely​ ​or​ ​the​ ​patient​ ​decides​ ​that​ ​their​ ​confidence​ ​and​ ​comfort​ ​is​ ​more​ ​important.
Most​ ​patients​ ​use​ ​their​ ​brace​ ​as​ ​a​ ​crutch​ ​and​ ​rely​ ​on​ ​that​ ​brace​ ​to​ ​not​ ​let​ ​them​ ​injure​ ​their​ ​ACL
again​ ​and​ ​that​ ​is​ ​the​ ​doctor’s​ ​reasoning​ ​for​ ​telling​ ​the​ ​patient​ ​to​ ​wear​ ​the​ ​brace​ ​indefinitely​ ​but
that​ ​makes​ ​the​ ​patient​ ​scared​ ​to​ ​do​ ​activity​ ​without​ ​their​ ​brace​ ​on.​ ​Our​ ​question​ ​and​ ​evidence
concludes​ ​that​ ​there​ ​is​ ​no​ ​specific,​ ​textbook​ ​answer​ ​on​ ​what​ ​to​ ​do​ ​for​ ​every​ ​post​ ​surgical​ ​ACL
tear​ ​patient.​ ​This​ ​is​ ​significant​ ​because​ ​we​ ​have​ ​thought​ ​as​ ​a​ ​group​ ​that​ ​it​ ​is​ ​the​ ​clinician​ ​or
doctor’s​ ​choice​ ​as​ ​to​ ​wear​ ​a​ ​brace​ ​or​ ​not.​ ​We​ ​have​ ​learned​ ​that​ ​it​ ​is​ ​ultimately​ ​the​ ​patient’s
choice​ ​as​ ​whether​ ​or​ ​not​ ​to​ ​wear​ ​the​ ​brace​ ​but​ ​the​ ​clinician​ ​or​ ​doctor​ ​having​ ​an​ ​opinion​ ​sways
them​ ​to​ ​wear​ ​the​ ​brace​ ​or​ ​not.​ ​The​ ​clinician​ ​or​ ​doctor​ ​has​ ​to​ ​give​ ​the​ ​patient​ ​hope​ ​that​ ​their
reconstructed​ ​ACL​ ​will​ ​hold​ ​up​ ​with​ ​or​ ​without​ ​the​ ​brace.

Recommendations​ ​for​ ​Future​ ​Research

To​ ​this​ ​day​ ​there​ ​has​ ​been​ ​various​ ​forms​ ​of​ ​research​ ​conducted​ ​to​ ​show​ ​the​ ​benefits​ ​of​ ​either
wearing​ ​an​ ​ACL​ ​brace​ ​or​ ​choosing​ ​to​ ​not​ ​wear​ ​one.​ ​With​ ​some​ ​clinician’s​ ​suggesting​ ​the​ ​use​ ​of
a​ ​brace​ ​and​ ​others​ ​stating​ ​that​ ​they​ ​recommend​ ​wearing​ ​the​ ​brace​ ​for​ ​only​ ​a​ ​few​ ​months​ ​post
operation​ ​it​ ​is​ ​hard​ ​to​ ​decide​ ​which​ ​is​ ​the​ ​better​ ​option.​​ ​There​ ​needs​ ​to​ ​be​ ​more​ ​research​ ​done
as​ ​to​ ​why​ ​which​ ​one​ ​is​ ​better​ ​than​ ​the​ ​other​ ​when​ ​returning​ ​to​ ​play.​ ​The​ ​patients​ ​that​ ​are​ ​used
for​ ​the​ ​study​ ​should​ ​be​ ​all​ ​around​ ​the​ ​same​ ​age,​ ​grouped​ ​by​ ​type​ ​of​ ​surgery,​ ​and​ ​to​ ​be​ ​most
specific,​ ​could​ ​be​ ​sport​ ​specific​ ​so​ ​everything​ ​is​ ​constant​ ​and​ ​the​ ​results​ ​would​ ​purely​ ​be​ ​on​ ​the
brace​ ​or​ ​no​ ​brace​ ​rather​ ​than​ ​comparing​ ​a​ ​30​ ​year-old​ ​male​ ​to​ ​a​ ​17​ ​year-old​ ​female.​ ​The
participants​ ​or​ ​patients​ ​need​ ​to​ ​be​ ​more​ ​of​ ​a​ ​constant​ ​in​ ​that​ ​sense.

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REFERENCES:
Theoret,​ ​D.,​ ​Lamontagne,​ ​M.​ ​Study​ ​on​ ​three-dimensional​ ​kinematics​ ​and​ ​electromyography​ ​of
ACL​ ​deficient​ ​knee​ ​participants​ ​wearing​ ​a​ ​functional​ ​knee​ ​brace​ ​during​ ​running.​ K
​ nee​ ​Surg
Sports​ ​Traumatol​ ​Arthrosc.​ ​2006;​ ​1:​ ​1-11.

Mikkelsen,​ ​C,​ ​Cerulli,​ ​G,​ ​Lorenzini,​ ​M,​ ​Bergstrand,​ ​G,​ ​Werner,​ ​S.​ ​Can​ ​a​ ​post-operative​ ​brace​ ​in
slight​ ​hyperextension​ ​prevent​ ​extension​ ​deficit​ ​after​ ​anterior​ ​cruciate​ ​ligament​ ​reconstruction?
Knee​ ​Surg​ ​Sports​ ​Traumatol​ ​Arthrosc.​ ​2003;​ ​318-321.

​ nee​ ​bracing​ ​after

Birmingham,​ ​T,​ ​Kramer,​ ​J,​ ​Kirkley,​ ​A,​ ​Inglis,​ ​J,​ ​Spaulding,​ ​S,​ ​Vandervoort,​ ​A.​ K
ACL​ ​reconstruction:​ ​effects​ ​on​ ​postural​ ​control​ ​and​ ​proprioception.​ A ​ merican​ ​College​ ​of​ ​Sports
Medicine.​ ​2001;​ ​1253-1258

Mallory,​ ​N,​ ​Ketchell,​ ​D,​ ​Lord,​ ​J.​ ​Does​ ​a​ ​knee​ ​brace​ ​decrease​ ​recurrent​ ​ACL​ ​injuries?​ T
​ he
journal​ ​of​ ​Family​ ​Practice.​ ​2003​ ​10,​ ​803-804.

Stanley,​ ​C,​ ​Gross,​ ​M,​ ​Garrett,​ ​W.​ ​Effects​ ​of​ ​a​ ​Knee​ ​Extension​ ​Constraint​ ​Brace​ ​on​ ​Lower
Extremity​ ​Movements​ ​after​ ​ACL​ ​Reconstruction.​ ​Clin​ ​Orthop​ ​Relat​ ​Res.​ ​2011;​ ​469:​ ​1774-1780.

Mayr,​ ​H,​ ​Stueken,​ ​P,​ ​Munch,​ ​E,​ ​Wolter,​ ​M,​ ​Bernstein,​ ​A,​ ​Suedkamp,​ ​N,​ ​Stoehr,​ ​A.​ B ​ race​ ​or
no-brace​ ​after​ ​ACL​ ​Graft?​ ​Four-year​ ​results​ ​of​ ​a​ ​prospective​ ​clinical​ ​trial.​ K
​ nee​ ​Surg​ ​Sports
Traumatol​ ​Arthrosc.​ ​2014;​ ​22:​ ​1156-1162.