Functional bracing of ACL injuries: current state and future directions

Smith, Sean D.; LaPrade, Robert F.; Jansson, Kyle S.; Årøen, Asbjørn; Wijdicks, Coen A.

doi:10.1007/s00167-013-2514-z

Cited by 45 publications

(43 citation statements)

References 88 publications

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“…In human medicine, knee braces are commonly used for multiple conditions (13)(14)(15)(16)(17)(18)(19). Bracing of the human knee has been shown to enhance proprioception/joint position sense, permit the injured limb to relax, reduce fatigue in injured limb, provide some mechanical protection against impact, and slow movement down to allow muscles time to react and control motion (14,(17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

“…neutralizing cranial tibial thrust in the ACL deficient knee). One recent review reported that biomechanical evaluations of functional braces have been mixed and concluded further functional brace studies designed to apply forces to the knee joint similar in magnitude to the native ACL should be performed (16). In spite of this, functional knee braces are still thought to be effective in controlling anteroposterior translation in ACL-deficient knees under low loading conditions (17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

“…In spite of this, functional knee braces are still thought to be effective in controlling anteroposterior translation in ACL-deficient knees under low loading conditions (17)(18)(19)(20)(21)(22). However, knee braces are not believed to be effective under high loading conditions, such as those that occur during athletic activity (16,17,20,21).…”

Section: Introductionmentioning

confidence: 99%

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The Use of Canine Stifle Orthotics for Cranial Cruciate Ligament Insufficiency

Carr¹,

Canapp²,

Meilleur³

et al. 2016

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Objective: To assess weight bearing of dogs treated for unilateral cranial cruciate ligament insufficiency with a custom stifle orthotic.Background: Cranial cruciate ligament (CCL) insufficiency is the most common cause of hind limb lameness in dogs. While there are numerous options for surgical management, surgery is not always an option. Recently, the use of canine stifle orthotics has also emerged as a means to non-surgically manage patients with cranial cruciate ligament insufficiency.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Use of Canine Stifle Orthotics for Cranial Cruciate Ligament Insufficiency

Carr¹,

Canapp²,

Meilleur³

et al. 2016

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“…For example, the ligament is well vascularized, which is required for tissues healing [8, 9]. Different methods have been undertaken to enhance healing of the ACL, including primary suture repair, healing response techniques, immobilization, bracing, and supplementation with scaffolds, growth factors, and collagen-platelet composites [5, 10–14]. Although primary ACL suture has been shown to improve laxity in the short term, it has shown a high failure rate with longer follow-up [5, 11, 14].…”

Section: Introductionmentioning

confidence: 99%

“…Although primary ACL suture has been shown to improve laxity in the short term, it has shown a high failure rate with longer follow-up [5, 11, 14]. Several functional knee braces have been evaluated and noted not to affect knee anterior laxity [10, 15, 16]. Fujimoto et al, however, showed in a group of 31 patients with low athletic demands that bracing with an extension block improved stability in 74% of patients, but 26% of the patients went on to require ACL reconstruction [17].…”

Section: Introductionmentioning

confidence: 99%

Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace

Jacobi

Reischl

Rönn

et al. 2016

Advances in Orthopedics

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Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation.

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Functional anterior cruciate ligament braces may have a role in select patient groups although there is presently limited evidence supporting or refuting their routine use: A scoping review of clinical practice guidelines and an updated bracing classification

Geeslin,

Moatshe,

Engebretsen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to perform a scoping review of clinical practice guidelines (CPGs) concerning the use of functional anterior cruciate ligament (ACL) braces and to clarify the nomenclature for bracing relevant to ACL injury treatment in order to support prescribing clinicians.MethodsA PubMed search for CPGs for the use of braces following ACL injury or reconstruction was performed. CPGs on the treatment of ACL injuries with sufficient attention to postoperative braces were included in this scoping review. The references used for supporting the specific CPG recommendations were reviewed. Specific indications for brace use including brace type, period of use following surgery and activities requiring brace use were collected.ResultsSix CPGs were identified and included this this review. Three randomised trials provided the evidence for recommendations on functional brace use following ACL reconstruction in the six CPGs. Functional ACL braces were the primary focus of the three randomised trials, although extension braces (postoperative knee immobilisers) were also discussed. A novel dynamic ACL brace category has been described, although included CPGs did not provide guidance on this brace type.ConclusionsGuidance on the use of functional ACL braces following ACL reconstruction is provided in six CPGs supported by three randomised trials. However, the brace protocols and patient compliance in the randomised trials render these CPGs inadequate for providing guidance on the use of functional ACL braces in the general and high‐risk patient populations when returning to sport after ACL reconstruction. Functional ACL braces are commonly utilised during the course of ACL injury treatment although there is presently limited evidence supporting or refuting the routine use of these braces. Future studies are, therefore, necessary in order to provide guidance on the use of functional and dynamic ACL braces in high‐risk patient populations.Level of EvidenceLevel II.

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Functional bracing of ACL injuries: current state and future directions

Abstract: III.

Cited by 45 publications

References 88 publications

The Use of Canine Stifle Orthotics for Cranial Cruciate Ligament Insufficiency

The Use of Canine Stifle Orthotics for Cranial Cruciate Ligament Insufficiency

Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace

Functional anterior cruciate ligament braces may have a role in select patient groups although there is presently limited evidence supporting or refuting their routine use: A scoping review of clinical practice guidelines and an updated bracing classification

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