Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction?

Miceli, R; Marambio, Carlotta Bustos; Zati, A.; Monesi, Roberta; Benedetti, Maria Grazia

doi:10.1055/s-0037-1606617

Cited by 8 publications

(7 citation statements)

References 31 publications

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“…Bracing and delayed weightbearing after isolated ACLR has been shown to decrease functional outcomes, based on IKDC scores, 21 but how this affects ACLR in conjunction with meniscal treatment has not been evaluated. Although there appeared to be some functional benefit to early motion and early weightbearing or some detriment to limitation at the midterm for isolated ACLR, our study found this did not hold true with concomitant meniscal treatment.…”

Section: Discussionmentioning

confidence: 99%

Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction

Aaron

Bodkin

Gwathmey

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Meniscal injuries are commonly associated with anterior cruciate ligament (ACL) tears. Treatment of meniscal injuries can impart delayed weightbearing and range of motion restrictions, which can affect the rehabilitation protocol. The effect of meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction is unclear. Purpose/Hypothesis: The purpose of this study was to compare strength, jumping performance, and patient-reported outcomes between patients who underwent isolated ACL reconstruction (ACLR) and those who underwent surgical intervention for meniscal pathology at the time of ACLR. Our hypothesis was that patients who underwent concurrent meniscal repair (MR) would have lower strength recovery owing to postoperative restrictions. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with ACLR were stratified into isolated ACLR, ACLR and meniscectomy (ACLR-MS), or ACLR-MR groups and were compared with healthy controls. The ACLR-MR group was restricted to partial weightbearing and to 90° of knee flexion for the first 6 weeks postoperatively. All participants completed patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups as part of a return-to-sports test battery at 5 to 7 months postoperatively. Results: A total of 165 patients with ACLR (50 with isolated ACLR, 44 with ACLR-MS, and 71 with ACLR-MR) and 140 healthy controls were included in the study. Follow-up occurred at a mean of 5.96 ± 0.47 months postoperatively. The control group demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than did the ACLR-MS and ACLR-MR groups combined ( P < .001 for all). There were no differences in IKDC, KOOS subscales, or unilateral or limb symmetry measures of peak knee extensor or flexor torque among the isolated ACLR, ACLR-MS, and ACLR-MR groups. Conclusion: Persistent weakness, asymmetry, and reduced subjective outcome scores at 6-month follow-up after ACLR were not influenced by meniscal treatment. These findings suggested that the weightbearing and range of motion restrictions associated with meniscal repair recovery do not result in loss of early strength or worse patient-reported outcomes.

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Section: Discussionmentioning

confidence: 99%

Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction

Aaron

Bodkin

Gwathmey

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Postoperative knee bracing after ACLR has been shown to be associated with some additional adverse effects to the operated knee. Di Miceli et al [ 43 ] . showed that the use of a brace and delayed weight bearing after ACLR have a negative impact on long-term functional outcomes, according to the subjective IKDC score.…”

Section: Discussionmentioning

confidence: 99%

Can a Knee Brace Prevent ACL Reinjury: A Systematic Review

Marois

Tan

Pauyo

et al. 2021

IJERPH

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This systematic review aimed to investigate whether the use of a knee brace when returning to sport (RTS) could prevent a second injury after anterior cruciate ligament reconstruction (ACLR). This study was registered with the PROSPERO database and followed PRISMA guidelines. A systematic search of PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, EBSCO Sportdiscus and ISI Web of Science databases for meta-analysis, randomized controlled trials and prospective cohort studies published before July 2020 was undertaken. The inclusion criteria were: (1) Comparing with and without a brace at RTS, (2) follow up of at least 18 months after ACLR, (3) reinjury rates included in the outcomes. Two reviewers independently extracted the data. Quality appraisal analyses were performed for each study using the Cochrane Collaboration tools for randomized and nonrandomized trials. A total of 1196 patients in three studies were included. One study showed a lower rate of reinjury when wearing a knee brace at RTS. One study found the knee brace to have a significant protective effect for younger patients (≤17 years). The effectiveness of knee bracing when RTS remains ambiguous. Current data cannot support that using a knee brace when RTS will decrease the rate of reinjury after ACL reconstruction.

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“…In total, 911 studies were eligible (Fig. 1), but only 9 studies qualified for inclusion (1,8,(11)(12)(13)(14)(15)(16)(17) (Table I). Due to the considerable variation in rehabilitation protocols across studies, for the purposes of the current study accelerated weight-bearing was defined as full weight-bearing within 2 weeks, and delayed weightbearing was defined as full weight-bearing beyond 2 weeks.…”

Section: Study Selectionmentioning

confidence: 99%

“…The 9 studies reported IKDC scores (11)(12)(13)(14), with 2 studies excluded in the meta-analysis (15, 16) (mean and SD were not provided). One study reported that the accelerated weight-bearing group showed a better score (12).…”

Section: Clinical Outcome Measuresmentioning

confidence: 99%

“…We performed surgical interventions within 1 day to 6 months after the initial injury. Surgical techniques were divided into 2 types, single-bundle (8,(11)(12)(13)(14)(15)(16)(17) and double-bundle (1), with surgery performed arthroscopically in all studies. In 5 studies, the accelerated weight-bearing group followed ROM exercise of the knee, while the delayed weight-bearing group immobilized the knee joint in the initial postoperative period (13)(14)(15)(16)(17).…”

Section: Intervention Descriptionmentioning

confidence: 99%

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Delayed versus Accelerated Weight-bearing Rehabilitation Protocol Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Fan¹,

Yan²,

Zhou³

et al. 2022

JRM

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Objective: To compare accelerated and delayed weight-bearing rehabilitation of anterior cruciate ligament reconstruction regarding clinical outcome measures of knee function (International Knee Documentation Committee Subjective Knee Form (IKDC), Lysholm Knee Scoring Scale, Tegner Activity Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS)), knee laxity, range of movement, quadriceps, and bone tunnel enlargement. Design: Systematic review and meta-analysis. Methods: Systematic searches of Embase, MEDLINE, CINAHL, and the Cochrane Library databases, from inception to February 2021, for studies comparing delayed or accelerated weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction in adult patients. Results: Nine studies met the eligibility criteria. A meta-analysis revealed a higher risk of knee laxity in the accelerated weight-bearing group. Accelerated weight-bearing may be related to higher IKDC scores, while there was no statistical difference for Lysholm, Tegner, and KOOS scores at a follow-up within 2 years. Four of 5 studies reported no statistical difference for quadriceps strength and range of movement scores, while 2 studies reported bone tunnel enlargement in the accelerated weight-bearing group. Conclusion: This systematic review confirmed that accelerated weight-bearing caused more serious knee laxity and bone tunnel widening than delayed weight-bearing after anterior cruciate ligament reconstruction. We therefore recommend that clinicians should select postoperative rehabilitation programmes with caution.

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Do Knee Bracing and Delayed Weight Bearing Affect Mid-Term Functional Outcome after Anterior Cruciate Ligament Reconstruction?

Cited by 8 publications

References 31 publications

Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction

Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction

Can a Knee Brace Prevent ACL Reinjury: A Systematic Review

Delayed versus Accelerated Weight-bearing Rehabilitation Protocol Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

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