ACL Knee Brace: Do You Need One?

ACL Knee Brace: Are They Effective?

We see lots of athletes at SSOR that have anterior cruciate ligament (ACL) reconstructions.  It’s no secret what an epidemic that ACL injuries are, especially in young female athletes.  It is well-documented that 75% of ACL injuries are non-contact and that young female athletes tear their ACL’s 2-8x more than males do.  Even more troubling is that current data suggest that up to 30% of athletes tear their other ACL or re-tear their reconstructed one within 2 years after surgery!  One question we address with every patient and their family is whether or not they need/should use a knee brace after ACL reconstruction when they return to sport.  Naturally, the PT’s at SSOR look to the research to guide our practice.  So what’s the data show on ACL knee braces?

Knee Braces: Necessary?

In a study by Smith et al in 2014 in Knee Surgery Sports Traumatology and Arthroscopy, researchers concluded that biomechanical and clinical evidence suggests current functional bracing technologies do not sufficiently restore normal biomechanics to the ACL-deficient knee, protect the reconstructed ACL, or improve long-term patient outcomes.  In another review, Bodendorfer et al (Phys Sports Med 2013) found that evidence supporting their efficacy in reducing or preventing injury remains limited.  Furthermore, several studies have found that ACL knee braces have little effect on knee stability, re-injury rates, or kinesthetic awareness (fancy term for knowing where your knee is in space) (McDevitt et al, AJSM 2004; Birmingham et al, AJSM 2008; Wright & Fetzer, CORR 2007; Beynnon et al, JOSPT 2002).   Despite all of this data showing that ACL knee braces really don’t do much, a study in 2003 by Decoster and Vailis in Orthopedics found that 87% of orthopedic surgeons prescribe them!
Trust us, there are even more older studies that effectively find the same thing – ACL knee braces really don’t do much to help prevent injury or re-injury.  Unfortunately, what is not known and what is very difficult to study is what braces do for the mental side of returning to sport – does having a brace make people “feel” better and more confident in their knee?  At this time, we just don’t know that.
One topic worth debating is which knee should be braced after ACL reconstruction?  While it may seem crazy, think about this – the reason why you have surgery in the first place is to restore stability to the knee where the ACL is torn.  Given the elevated risk of ACL injury to the other knee after injury to one knee, perhaps we should brace the unaffected knee if an athlete is going to wear one?  It’s something worth thinking about.

The SSOR Philosophy

In our view, braces are completely a choice between patient and/or parents and the doctor.  Regardless of what we suggest, the physician is in charge and the may want you to wear one.  Some athletes just feel they need them or parents may insist.  That is fine too!  If our opinion is asked, we typically do not recommend braces for a few reasons.  First of all, our patients do not wear their brace in rehab.  We want our patients to develop confidence in their knee without external support.  Sometimes, braces become a “security blanket” and athletes rely on them too much or give them a false sense of security that their knee is OK.  Therefore, if an athlete maybe forgets to pack their brace for a tournament out of town, the lack of the brace may be a mental barrier for them during competitive play.  Secondly, there is some belief that wearing a brace may give an athlete false sense of confidence that they can engage in more risky behaviors because “their brace will take care of them.”  Obviously, that is not true.  Third, athletes sometimes become targets in competitive play if they have a brace on.  Unfortunately, it’s just a reality in sports – there are just some selfish, short-sighted coaches (and sadly, parents!) who encourage their players to go after an athlete or well, just bad sports who target their opponents knee without any prodding.  Sometimes, an ACL knee brace can be a “bullseye” for an athlete with malicious intent.  Finally, as we stated earlier, the evidence just doesn’t support using them and given their cost, the benefit is likely not there.
All that said, skilled, structured rehabilitation and specific return to play progression helps improve confidence and minimize the risk of re-injury.  We’re confident that the approach we take at SSOR is as thorough, detailed, and specific as one can be.  Rest assured, you’ll be back on the field when you have passed our criteria and have demonstrated that confidence in the knee we talked about.  We know in the long run, this is the best approach to garner the most effective outcome.
It would be a privilege to serve you or your young athlete after their ACL injury and partner with you in their process of recovery.  Give us a call!  We’ve done it for athletes at every level and know what it takes to maximize your functional capabilities.

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