Is bracing after ACL surgery necessary?
It came up again in conversation earlier this week: am I wearing a brace on my knee now that I’m starting to get back to my normal sports? It’s easy to understand why you might think you need one judging by the number of manufacturers and retailers touting their benefits. The trouble is, I can’t find any controlled studies suggesting that there is any benefit to wearing a brace after ACL surgery. Braces have not shown to reduce post-op reinjury or complications. And they do not increase function or stability.
The first study I found from 1997, followed patients for 2 years. In that time two people suffered re-injury – one in the control group and one in the brace-wearing group. No other substantial differences were found.
About the time that this study was finishing, another study came out confirming that the use of prophylactic braces in sport did not prove to be effective. This study is especially important because it was a meta-study, aggregating data from multiple clinical and experimental studies. The authors concluded that no evidence of a significant bracing effect could be demonstrated.
Okay, you’re saying, those studies were a long time ago. ACL surgery and rehab has changed since then!
Right. In 2007, another systematic review of evidence confirmed that using a brace did not affect pain, range of motion, graft stability, or protection from subsequent injury. A year later, a fourth study compared functional knee braces to neoprene sleeves for protection of ACL injured knees. This study actually began with the assumption that knee braces were effective and hypothesized that functional braces would be more effective than neoprene sleeves. Know what the found? Current evidence does not support the recommendation of using an ACL knee brace after ACL reconstruction.
I’m not telling anyone to not follow doctors orders with respect to wearing a brace (especially immediately post-op). And I’m not telling anyone they shouldn’t wear a brace if they want to. I just wanted to show that long-term, there isn’t any evidence supporting their use. If your doctor or PT recommends one, show them these studies and ask them to show you the counter-evidence that demonstrates they are effective. You should only have to to pay for medical treatments and devices that actually work!
I’ll finish by saying that I’m always open to changing my mind if evidence swings the other way, so please leave me a comment if you’ve found something that I didn’t!