Innovative rehabilitative bracing with applied resistance improves walking pattern recovery in the early stages of rehabilitation after ACL reconstruction: a preliminary investigation

Abstract

Background The use of knee braces early after anterior cruciate ligament (ACL) reconstruction is a controversial issue. The study preliminarily compares the effect of a traditional brace blocked in knee extension and a new functional brace equipped with a spring resistance on walking and strength performance early after ACL reconstruction performed in the acute/subacute stage. Methods 14 ACL-reconstructed patients wore either a traditional (Control group: CG, 7 subjects) or a new functional brace (Experimental group: EG 7 subjects) until the 30th post-operative day. All patients were tested before surgery (T0), 15, 30, and 60 days after surgery (T1, T2, and T3, respectively). Knee angular displacement and ground reaction forces (GRF) during the stance phase of the gait cycle were analyzed at each session and, at T3, maximal voluntary isometric contraction (MVIC) for knee flexor/extensor muscles was performed. Limb symmetry indexes (LSI) of GRF and MVIC parameters were calculated. Results At T3, EG showed greater peak knee flexion angle of injured limb compared to CG (41 ± 2° vs 32 ± 1°, p < 0.001). During weight acceptance, a significant increase of anteroposterior GRF peak and vertical impulse from T1 to T3 was observed in the injured limb in EG (p < 0.05) but not in CG (p > 0.05). EG showed a greater side-to-side LSI of weight acceptance peak of anteroposterior GRF at T2 (113 ± 23% vs 69 ± 11%, p < 0.05) and T3 (112 ± 23% vs 84 ± 10%, p < 0.05). Conclusions The preliminary findings from this study indicate that the new functional brace did help in improving gait biomechanical pattern in the first two months after ACL reconstruction compared to a traditional brace locked in knee extension.

The Role of Bracing in ACL Injuries: The Current Evidentiary State of Play

“…There are bracing technologies that include application of dynamic posterior loads with various knee flexion as well as resistance which may assist with early rehabilitation, improve kinematics, and further reduce anterior tibial translation. 61,62 As technology and materials improve in bracing, the role of bracing around ACL injuries will likely need to be revisited.…”

Functional Resistance Training Improves Thigh Muscle Strength after ACL Reconstruction: A Randomized Clinical Trial

“…ACL reconstruction participants in the FRT BRACE group realized, on average, a 42% increase in strength from preintervention to postintervention, whereas the TARGET MATCH group only realized an 18% change. Previous work in ACL reconstruction patients comparing a group receiving FRT during walking with a group receiving no FRT failed to show improvements in thigh muscle strength (33). Direct comparison of our work with this prior study is difficult because of the different brace design, resistance dosage, and time of brace application.…”

Functional Bracing Following Anterior Cruciate Ligament Reconstruction

“…While many postoperative knee braces are available, standard practice has shifted away from bracing with immobilization to bracing that allows early knee range of motion following ACL reconstruction [6][7][8] . In particular, the use of functional bracing following ACL reconstruction is highly debated.…”

“…In the setting of ACL rupture with subsequent reconstruction, the risk of graft rupture is greatest in the 12 months after reconstruction 4 , with complete graft homeostasis reported to require approximately 2 years of postsurgical healing 5 . Various modalities are currently utilized during ACL rehabilitation, with variable reports regarding optimal time to full weight-bearing, phys-ical therapy protocols, and the use of postoperative bracing [6][7][8] .…”