The Effectiveness of Functional Bracing in Athletes with Anterior Cruciate Ligament Reconstruction on Function, Stability, and Biomechanics: A Critically Appraised Topic

Context: There are approximately 200,000 anterior cruciate ligament (ACL) injuries per year in the United States and about half of these injuries undergo ACL reconstruction (ACLR). Currently, the treatment for ACLs post reconstructive surgery often involves the use of a functional brace to aid in the rehabilitation process by providing stabilization and protection to the graft by reducing mechanical loads and supporting early motion. According to the American Orthopedic Society for Sports Medicine (AOSSM), postoperative braces are used in 85% of ACLR cases. While the effectiveness of the use of a functional brace post ACLR for return to sports, or high levels of physical activity, is still unclear, many physicians still opt to prescribe and recommend bracing for the first postoperative year. In conclusion, the most effective use of a functional brace post anterior cruciate ligament reconstruction still remains unclear.

Clinical Question: What is the efficacy of functional bracing on the function, stability, and biomechanics in athletes with reconstructed anterior cruciate ligaments?

Summary of Key Findings: A search of the following databases was conducted in November 2020 using the search terms: anterior cruciate ligament reconstruction; bracing; kinematic; knee instability, kinetics; ACL functional brace (PubMed, TRIP Medical Database, Journal of Athletic Training, PEDro Database, Google Scholar). Only peer-reviewed articles that were randomized control trials or systematic reviews were included in the analysis. Of the three included studies, all report significant results supporting the idea that bracing of the ACL post ACLR surgery does not improve long-term patient outcomes and clinical outcomes on the function and stability of ACL reconstructed knees.

Clinical Bottom Line: There is moderate evidence to support the idea of discontinuing the use of ACL functional braces post ACLR surgery for function and stabilization of the ACL reconstructed knee. Currently, no existing functional brace has been successful to restore normal anterior stability to the ACL deficient knee and improve long term patient outcomes following ACLR.