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 Worn in the early postoperative period (0-6 weeks). 1  Lightweight metal hinge bars with multiple padded velcro straps to secure brace to patient’s.

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Presentation on theme: " Worn in the early postoperative period (0-6 weeks). 1  Lightweight metal hinge bars with multiple padded velcro straps to secure brace to patient’s."— Presentation transcript:

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2  Worn in the early postoperative period (0-6 weeks). 1  Lightweight metal hinge bars with multiple padded velcro straps to secure brace to patient’s thigh and lower leg. 2  Intended to limit range of motion by locking the brace at a specific ROM point, or within certain ROM limits through an adjustable dial at the hinges. 1  Designed to limit extension/flexion motion and varus and valgus stresses at the knee. 1

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4  Postoperative bracing has been shown to have some benefits including decreased swelling, hemarthrosis, and pain compared to rehabilitation without a brace. 3,4 › Knee immobilizer or post-op. brace  Proponents believe these braces help patients achieve knee extension, decrease pain, and protect the reconstructed knee from injury and excessive graft strain. 1

5  Immediate postoperative bracing allows early weight bearing while protecting the knee from buckling due to severe quadriceps weakness and inhibition after surgery. 3  Once the patient obtains good quadriceps control with ability to perform a straight leg raise without an extension lag, use of the postoperative brace can be discontinued. 4

6  Rehabilitative bracing has not been shown to have any effect on long-term outcomes. › Once adequate quadriceps strength for ambulation has returned, continued postoperative bracing is unnecessary. 3 › Clinical outcomes such as range of motion, laxity, and function do not appear to be affected by the use of rehabilitative braces. 4

7  Wright et al. 5 › Review of level 1 and 2 studies identified 54 appropriate randomized controlled trials of ACL rehabilitation,  11 included use of rehabilitative postop. bracing. › No study demonstrated a potentially worse outcome when bracing was not used immediately postoperatively.  No increased rate of injury, pain, decreased ROM, or increased laxity compared to braced patients › Only one study 6 demonstrated a potentially clinically significant finding.  Improved knee extension following one week of locked extension bracing postoperatively

8  Worn to potentially decrease the risk of reinjury when the patient returns to sport after surgery. 1  Wide variety of designs available as custom or off-the-shelf derotational braces for post-surgical ACL patients.  Consist of a rigid frame with hinge-post- straps and Velcro straps. 2  Intended to limit anterior tibial translation and rotation at the knee joint. 7

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10  Functional brace use after ACL reconstruction may: 3,7 › improve proprioception. › improve confidence in knee during return to play.

11  Use of functional braces after ACL reconstruction is controversial. 1,3,7,8  Majority of studies have failed to show any long-term differences in pain 1, ROM 1,3, strength 3, functional tests 3,7, joint stability 7,8, graft stability 1, re-injury rates 1,8, kinesthetic awareness 8, or knee scores 3 compared to patients who did not use a functional brace during rehabilitation and return to play after ACL reconstruction.

12  Rate of use by orthopedic surgeons 9 › Do you recommend functional braces for full return to activity?  Reports of recommended use of functional braces by US orthopedic surgeons have ranged from 58%- 63%. 9,10,11 YesNoSometimes NORTH AMERICA (199) 17.6% (35)37.2% (74)45.2% (90) EUROPE (35) 2.9% (1)31.4% (11)65.7% (23) SOUTH AMERICA (85) 1.2% (1)88.2% (75)10.6% (9)

13  Studies to determine the effect of functional braces on re-injury rates after ACL rsurgery have many limitations. › Lack of power: 3 Re-injury rates overall after ACL reconstruction are low, so the number of patients needed to power a study on re-injury rate is very high. › Wright 1 performed a review of Level I evidence to determine if there was appropriate evidence to support the use of functional braces after ACL reconstruction.  12 randomized controlled trials found between years  All 12 had potential biases- 10 selection, 2 exclusion

14  Sterett et al. 12 investigated the effect of functional bracing on subsequent knee injury in ACL reconstructed skiers.  Study performed over 2 years at large ski resort. › All subjects were employees  820 subjects with ACL reconstruction performed ≥2 yrs. prior to data collection were given the option of using a functional brace during skiing activity, or going brace- free. › 257 braced, 563 non-braced

15 Sterett et al, 12 continued  61 new injuries recorded › 51 non-braced (8.9 injuries/100 knees/season)  25 required surgery › 10 braced (4.0 injuries/100 knees/season)  3 required surgery › Non-braced group was 2.74 times more likely to be injured than braced group.  Use of a brace did not lower injury rate to that of a skier with no previous ACL injury (2.1%).

16 1. Wright RW & Fester GB. Bracing after ACL reconstruction: A systematic review. Clin Orthop Relat Res. 2007;455: doi: /BLO.0b013e31802c Beam JW. Orthopedic Taping, Wrapping, Bracing & Padding. 2 nd ed. Philadelphia, PA: F.A. Davis Company, Albright JC & Crepeau AE. Functional bracing and return to play after anterior cruciate ligament reconstruction in the pediatric and adolescent patient. Clin Sports Med. 2011;30: doi: /j.csm Manske RC, Prohanska D, & Lucas B. Recent advances following anterior cruciate ligament reconstruction: Rehabilitation perspectives. Curr Rev Musculoskelet Med. 2012;5(1): Wright RW, et al. A systematic review of anterior cruciate ligament reconstruction rehabilitation: Part I: Continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation. J Knee Surg. 2008;21: Melegati G, et al. The role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction: A prospective controlled study. Knee Surg Sports Traumatol Arthrosc. 2003;11: Birmingham TB, et al. A randomized control trial comparing the effectiveness of functional knee brace and neoprene sleeve use after anterior cruciate ligament reconstruction. AJSM. 2008;36(4): doi: / Pezzullo DJ & Fadale PF. Current controversies in rehabilitation after anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev. 2010;18(1): Cook C et al. Continental variations in preoperative and postoperative management of patients with anterior cruciate ligament repair. Eur J Phys Rehabil Med. 2008;44(3): Marx RG et al. Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Arthroscopy. 2003;19: Wentzensen A & Hochstein P. Management of anterior cruciate ligament rupture: Indications, choice of procedure, timing, concomitant and aftercare. Zentralbl Chir. 1998;123: Sterett WI, Briggs KK, Farley T, Steadman, JR. Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction. AJSM. 2006;34(10): doi: /

17 a. Use of Knee Braces in Comprehensive Knee Rehabilitation & Knee Pain Management. Availableat b. c. Capitaldealsonline.com/store/the-bledsoe-rehab-knee-brace-regular-red-w-quicklok-hinge/ d. Rishiraj et al. Functional knee bracing and athletic performance. Journal of Foot and Ankle Research.2011, Available at review.com/article/functional-knee-bracing-and- athletic-performance e.


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