To brace or not to brace after ACL surgery?

Q: To brace or not to brace: that is the ACL question. I'm going to have surgery tomorrow(!) to reconstruct my ACL. I've been told by one person that I'll be wearing a brace after surgery to protect the knee. But then I heard someone else say bracing isn't necessary and just adds to the cost. Which is it, really?

A: It has been known for many years now that bracing after surgery to reconstruct a ruptured anterior cruciate ligament (ACL) just isn't needed. Study after study have shown there isn't any benefit to bracing no matter what type of brace is used, when it is used, or how it is used.

This message was repeated once again in a recent systematic review of the literature conducted by orthopedic surgeons at Washington University School of Medicine in St. Louis. They searched for all articles on the rehabilitation after ACL reconstruction from 2006 to 2010. There were 29 high-quality studies that could be included for the review and analysis.

Patients who used braces to limit knee motion and protect against too much movement from side to side did not have any different results compared with patients who did not use a brace. Recovery was not statistically improved in either group (with brace, without brace). Measures used to judge differences between the two groups included level of pain, number of reinjuries, joint range-of-motion, or knee stability.

Many surgeons still do provide their patients with a brace after ACL reconstructive surgery. But the experts in this field keep trying to get the word out that bracing just isn't effective and shouldn't be part of the postoperative protocol. This is an area where clinical practice has not fully caught up to the research yet.

Reference: L.M. Kruse, MD, et al. Rehabilitation After Anterior Cruciate Ligament Reconstruction. In The Journal of Bone and Joint Surgery. October 3, 2012. Vol. 94A. No. 19. Pp. 1737-1748.

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