Health

Knee brace may help torn anterior cruciate ligaments heal themselves

In a study involving 80 people with ruptured anterior cruciate ligaments, 90 per cent had signs of healing
after three months of wearing a specialised knee brace

22 June 2023

By Clare Watson

A study participant wears a specialised knee brace designed to support healing of the anterior cruciate
ligament

Stephanie Filbay

The vast majority of torn anterior cruciate ligaments (ACL) can heal themselves with the help of a
specialised knee brace, a small study has found.

A ruptured ACL is a common sports injury that is usually treated with reconstructive surgery to replace
the torn ligament. Last year, Stephanie Filbay at the University of Melbourne in Australia and her
colleagues found that about 30 per cent of people who opted to defer surgery and try rehabilitation had
some degree of ACL healing after two years.

In their latest study, Filbay and her colleagues tested a knee brace designed to promote healing by
reducing the gap between the ligament’s two torn ends. The braced knee is immobilised at a right angle
for the first four weeks and the patient exercises the muscles above the knee by clenching to reduce
muscle wasting. Then the brace is adjusted to gradually increase the person’s range of knee motion over
eight weeks, with more strengthening exercises added.

The study included 80 people who attended a private exercise physician’s clinic in Australia with
complete ACL ruptures. Ninety per cent had signs of ACL healing after three months of wearing the
brace. MRI scans showed their ACLs regrew to form one continuous length, though the ligament was
either skinnier, thicker or saggier than before injury.

“It was a very surprising and overwhelming number” compared with the roughly one-third of people
whose ACLs healed in the previous trial with only rehabilitation, says Filbay.

More than 90 per cent of people whose ACLs mended thick returned to their chosen sport within 12
months, as did 62 per cent of people with thinly healed or sagging ACLs. But 14 per cent of the entire
group tore their ACL again within a year – which is in the same ballpark as reinjury rates post-surgery.

Without a control group in the study, no direct comparisons can be made between using the knee brace,
rehabilitation without one or outcomes following surgery, says Filbay. The team is planning two
randomised clinical trials to compare the approaches directly.

“Certainly, these results suggest [knee bracing] helps to facilitate the spontaneous healing of the ACL,”
says Adam Culvenor at La Trobe University in Melbourne, who wasn’t involved in the work.

However, he cautions that people shouldn’t try knee bracing themselves without medical supervision.
Immobilising the knee for a month comes with a risk of blood clotting and can also be functionally
disabling: wearers can’t straighten their leg, walk, drive or possibly work. Bracing is “not for everyone”
and needs further long-term study, he says.

Journal reference:

British Journal of Sports MedicineDOI: 10.1136/bjsports-2023-106931