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Li D, Li H, Hang Y. Hybrid feature-time series neural network for predicting ACL forces in martial artists with resistive braces after reconstruction. Front Bioeng Biotechnol 2025; 13:1579472. [PMID: 40416312 PMCID: PMC12098068 DOI: 10.3389/fbioe.2025.1579472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 04/29/2025] [Indexed: 05/27/2025] Open
Abstract
Objective This study developed a hybrid neural network integrating multi-modal data to predict anterior cruciate ligament (ACL) forces during rehabilitation in martial artists using a novel resistive knee brace after ACL reconstruction. The goal was to leverage time-series biomechanical parameters and static clinical features to optimize postoperative recovery strategies. Methods A prospective cohort of 44 martial artists post-ACL reconstruction was randomized into an experimental group (EG, n = 22) using a resistive brace and a control group (CG, n = 22) using a traditional brace. Baseline demographics (height, weight), joint range of motion (ROM), and muscle strength were measured preoperatively (T0) and at 15 days (T1), 30 days (T2), and 60 days (T3) postoperatively. High-resolution kinematic and kinetic data were collected at T3, while ACL forces were computed at T3 using OpenSim musculoskeletal modeling. A feature-embedded temporal convolutional neural network (TCN) fused time-series gait data (T3) with static features (T0-T3) to predict ACL forces. Results The hybrid TCN model achieved superior ACL force prediction accuracy, with a mean R 2 = 0.63 (EG), R 2 = 0.58 (CG), and R 2 = 0.62 (combined cohort) in three-fold cross-validation. Comparative analyses demonstrated significant advantages over standalone TCN (R 2 = 0.54) and long short-term memory (R 2 = 0.51) models. Conclusion The integration of temporal biomechanical data and static clinical features enables accurate ACL force prediction, particularly for patients using resistive braces. This approach provides a novel tool to personalize rehabilitation protocols and validates the efficacy of resistive braces in modulating ACL loads, supporting their clinical adoption for athletes recovering from ACL injuries.
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Affiliation(s)
- Dongyue Li
- School of Physical Education, Guangzhou University, Guangzhou, China
| | - Haojie Li
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yang Hang
- Physical Education Department, Guangdong University of Foreign Studies, Guangzhou, Guangdong, China
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Bixby EC, Heyworth BE. Management of Anterior Cruciate Ligament Tears in Skeletally Immature Patients. Curr Rev Musculoskelet Med 2024; 17:258-272. [PMID: 38639870 PMCID: PMC11156825 DOI: 10.1007/s12178-024-09897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries were historically treated nonoperatively, given concerns for physeal damage and subsequent growth disturbances after traditional ACL reconstruction techniques. However, there is now sufficient data to suggest superior outcomes with operative treatment, specifically with physeal-sparing and physeal-respecting techniques. This article reviews considerations of skeletal maturity in patients with ACL tears, then discusses surgical techniques, with a focus on their unique indications and outcomes. Additional surgical adjuncts and components of postoperative rehabilitation, which may reduce retear rates, are also considered. RECENT FINDINGS Current research shows favorable patient-reported outcomes and high return-to-sport rates after ACL reconstruction in skeletally immature patients. Graft rupture (ACL retear) rates are low, but notably higher than in most adult populations. Historically, there has been insufficient research to comprehensively compare reconstruction techniques used in this patient population. However, thoughtful systematic reviews and multicenter prospective studies are emerging to address this deficit. Also, more recent data suggests the addition of lateral extra-articular procedures and stringent return-to-sports testing may lower retear rates. Physeal-sparing and physeal-respecting ACL reconstructions result in stabilization of the knee, while respecting the growth remaining in children or skeletally immature adolescents. Future research will be essential to compare these techniques, given that more than one may be appropriate for patients of a specific age and skeletal maturity.
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Affiliation(s)
- Elise C Bixby
- Department of Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Benton E Heyworth
- Department of Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Brace-Free Rehabilitation after Isolated Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft Is Not Inferior to Brace-Based Rehabilitation-A Randomised Controlled Trial. J Clin Med 2023; 12:jcm12052074. [PMID: 36902868 PMCID: PMC10004240 DOI: 10.3390/jcm12052074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE The postoperative use of a rehabilitative knee brace after isolated primary anterior cruciate ligament (ACL) reconstruction (ACLR) using a hamstring tendon (HT) autograft is controversial. A knee brace may provide subjective safety but can cause damage if applied incorrectly. The aim of this study is to evaluate the effect of a knee brace on clinical outcomes following isolated ACLR using HT autograft. METHODS In this prospective randomised trial, 114 adults (32.4 ± 11.5 years, 35.1% women) underwent isolated ACLR using HT autograft after primary ACL rupture. Patients were randomly assigned to wear either a knee brace (n = 58) or no brace (n = 56) for 6 weeks postoperatively. An initial examination was performed preoperatively, and at 6 weeks and 4, 6, and 12 months. The primary endpoint was the subjective International Knee Documentation Committee (IKDC) score to measure participants' subjective perceptions. Secondary endpoints included objective knee function assessed by IKDC, instrumented knee laxity measurements, isokinetic strength tests of the knee extensors and flexors, Lysholm Knee Score, Tegner Activity Score, Anterior Cruciate Ligament-Return to Sport after Injury Score, and quality of life determined by Short Form-36 (SF36). RESULTS There were no statistically significant or clinically meaningful differences in IKDC scores between the two study groups (3.29, 95% confidence interval (CI) -1.39 to 7.97, p = 0.03 for evidence of non-inferiority of brace-free compared with brace-based rehabilitation). The difference in Lysholm score was 3.20 (95% CI -2.47 to 8.87); the difference in SF36 physical component score 0.09 (95% CI -1.93 to 3.03). In addition, isokinetic testing did not reveal any clinically relevant differences between the groups (n.s.). CONCLUSIONS Brace-free rehabilitation is non-inferior to a brace-based protocol regarding physical recovery 1 year after isolated ACLR using HT autograft. Consequently, the use of a knee brace might be avoided after such a procedure. LEVEL OF EVIDENCE Level I, therapeutic study.
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Prescription of knee braces after anterior cruciate ligament reconstruction: Fact or fiction? Turk J Phys Med Rehabil 2022; 68:355-363. [DOI: 10.5606/tftrd.2022.8906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: This study aims to compare the clinical results of patients rehabilitated with or without a rehabilitative knee brace (RKB) after anterior cruciate ligament (ACL) reconstruction.
Patients and methods: This retrospective, comparative study was conducted at between January 2013 and December 2017. A total of 119 patients (112 males, 7 females; mean age: 32.0±8.6 years; range, 18 to 45 years) with acute ACL ruptures treated with arthroscopic ACL reconstruction and rehabilitated with (n=56) or without RKB (n=63) participated in the study. The minimum follow-up time was 24 months. The ACL quality of life (QoL) questionnaire, Lysholm Knee Scoring Scale, and Tegner Activity Level Scale were used for the evaluation of the QoL, knee function, and activity level, respectively. The time to return to sports was recorded. The side-to-side difference in the anterior translation of the tibia was measured using a KT-1000 arthrometer.
Results: The mean follow-up time was 38.4±9.1 (range, 24 to 56) months. Baseline demographics and clinical characteristics were similar between groups. Regarding QoL, knee function, and activity level, no significant difference was observed between patients who used RKB and those who did not use it at the postoperative 12th month (p=0.95, p=0.56, p=0.98, respectively) and the latest follow-up (p=0.21, p=0.73, p=0.99, respectively). The mean time to return to sports (nearly 11 months for both groups) and side-to-side difference in the anterior tibial translation at the latest follow-up was also similar between groups (p=0.15 and p=0.15, respectively). There was no graft rupture during the follow-up in both groups. The complication rates were 7.9% and 7.1% for no brace and brace groups, respectively, without a statistically significant difference (p=0.87).
Conclusion: According to the results of this study, there was no significant difference between the rehabilitative brace and no brace groups in clinical outcomes after ACL reconstruction.
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Blecha K, Nuelle CW, Smith PA, Stannard JP, Ma R. Efficacy of Prophylactic Knee Bracing in Sports. J Knee Surg 2022; 35:242-248. [PMID: 34952553 DOI: 10.1055/s-0041-1740930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are common knee injuries, which can result from contact and noncontact during sports, recreation, or work-related activities. Prophylactic knee braces (PKBs) have been designed to protect the knee and decrease risk of recurrence of these injuries. Despite their success, PKBs have not been proven to be consistently effective and cost of the device must be evaluated to optimize its use in sports, particularly American football. Biomechanical studies have suggested that increased hip and knee flexion angles may reduce frontal plane loading with bracing which can protect the knee joint. This is essential with knee loading and rotational moments because they are associated with jumping, landing, and pivoting movements. The clinical efficacy of wearing PKBs can have an impact on athletic performance with respect to speed, power, motion, and agility, and these limitations are evident in athletes who are unaccustomed to wearing a PKB. Despite these concerns, use of PKBs increases in patients who have sustained an MCL injury or recovering from an ACL reconstruction surgery. As the evidence continues to evolve in sports medicine, there is limited definitive data to determine their beneficial or detrimental effects on overall injury risk of athletes, therefore leading those recommendations and decisions for their usage in the hands of the athletic trainers and team physicians' experience to determine the specific brace design, brand, fit, and situations for use.
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Affiliation(s)
- Kyle Blecha
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri
| | - Clayton W Nuelle
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri
| | - Patrick A Smith
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Columbia Orthopedic Group, Columbia, Missouri
| | - James P Stannard
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri.,Department of Orthopedic Surgery, Thompson Laboratory of Orthopedic Institute, University of Missouri, Columbia, Missouri
| | - Richard Ma
- Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri
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Knee Pads Do Not Affect Physical Performance in Young Female Volleyball Players. CHILDREN-BASEL 2021; 8:children8090748. [PMID: 34572180 PMCID: PMC8470544 DOI: 10.3390/children8090748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022]
Abstract
Knee pads have become increasingly popular among volleyball players. Given the fact high-intensity activities that are crucial to successfully playing this sport lead to an increased risk of a knee injury, the primary use of knee pads is to prevent potential injury. However, no research has been carried out to explain the effects of knee pads on the most important physical abilities in volleyball players, thus directly affecting performance. This study was undertaken to determine the effects of knee pads on the explosive power of the lower extremities, linear speed, and agility in young female volleyball players. In two separated sessions, 84 female volleyball players (age: 14.83 ± 0.72 years; height: 163.19 ± 8.38 cm; body mass: 53.64 ± 10.42 kg; VE: 5.30 ± 3.39 years) completed squat jumps (SJ), countermovement jumps (CMJ) with and without arm swing, linear sprints at 5-m and 10-m, modified t-test, and 5-10-5 shuttle test. Data analyses included descriptive statistics, paired sample T-tests and use of effect size (ES). There was no statistical difference between the two conditions for SJ (p = 0.156; ES = 0.18), CMJ (p = 0.817; ES = 0.03), CMJ with arm swing (p = 0.194; ES = 0.14), linear sprint at 5 m (p = 0.789; ES = 0.03) and 10 m (p = 0.907; ES = −0.01), modified t-test (p = 0.284; ES = 0.13), and 5-10-5 shuttle test (p = 0.144; ES = 0.19). Wearing knee pads has neither an inhibitory nor positive effects on explosive power of the lower extremities, linear speed, and agility in young female volleyball players.
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Dickerson LC, Peebles AT, Moskal JT, Miller TK, Queen RM. Physical Performance Improves With Time and a Functional Knee Brace in Athletes After ACL Reconstruction. Orthop J Sports Med 2020; 8:2325967120944255. [PMID: 32851108 PMCID: PMC7425272 DOI: 10.1177/2325967120944255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/24/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Athletes who return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) often have reduced physical performance and a high reinjury rate. Additionally, it is currently unclear how physical performance measures can change during the RTS transition and with the use of a functional knee brace. Purpose/Hypothesis: The purpose of this study was to examine the effects of time since surgery (at RTS and 3 months after RTS) and of wearing a brace on physical performance in patients who have undergone ACLR. We hypothesized that physical performance measures would improve with time and would not be affected by brace condition. Study Design: Controlled laboratory study. Methods: A total of 28 patients who underwent ACLR (9 males, 19 females) completed physical performance testing both after being released for RTS and 3 months later. Physical performance tests included the modified agility t test (MAT) and vertical jump height, which were completed with and without a knee brace. A repeated-measures analysis of variance determined the effect of time and bracing on performance measures. Results: The impact of the knee brace was different at the 2 time points for the MAT side shuffle (P = .047). Wearing a functional knee brace did not affect any other physical performance measure. MAT times improved for total time (P < .001) and backpedal (P < .001), and vertical jump height increased (P = .002) in the 3 months after RTS. Conclusion: The present study showed that physical performance measures of agility and vertical jump height improved in the first 3 months after RTS. This study also showed that wearing a knee brace did not hinder physical performance. Clinical Relevance: Wearing a functional knee brace does not affect physical performance, and therefore a brace could be worn during the RTS transition without concern. Additionally, physical performance measures may still improve 3 months past traditional RTS, therefore justifying delayed RTS.
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Affiliation(s)
- Laura C Dickerson
- Kevin P. Granata Biomechanics Lab, Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Alexander T Peebles
- Kevin P. Granata Biomechanics Lab, Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Thomas K Miller
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Robin M Queen
- Kevin P. Granata Biomechanics Lab, Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA.,Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Hop testing symmetry improves with time and while wearing a functional knee brace in anterior cruciate ligament reconstructed athletes. Clin Biomech (Bristol, Avon) 2019; 70:66-71. [PMID: 31404758 DOI: 10.1016/j.clinbiomech.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is currently no consensus among orthopaedic surgeons as to when patients with anterior cruciate ligament reconstruction are ready to return to sport or whether or not patients should wear a functional knee brace during athletic activity. The purpose of the present study was to determine the effects of time since return to sport and of a functional knee brace on hop distance and loading symmetry during hop testing in patients with anterior cruciate ligament reconstruction. METHODS Twenty-eight patients with anterior cruciate ligament reconstruction completed hop testing after being released to return to sport and again 3 months later, both with and without wearing a custom fit extension constraint functional knee brace. The loadsol® captured plantar loading data (100 Hz) to quantify peak impact force, loading rate, and impulse during the final landing of every hop test. A limb symmetry index was calculated between surgical and non-surgical limbs for hop distance and loading measures. FINDINGS Wearing a knee brace increased hop distance symmetry during the single and crossover hop tests and peak impact force symmetry on each test (all p < 0.05). While single (p = 0.022) and triple (p = 0.002) hop distance symmetry increased with time, there was no effect of time on any loading symmetry outcomes. INTERPRETATION These results support using a functional knee brace during athletic activities for improving symmetry in the early return to sport period. These results also support previous findings that while hop distance symmetry improves with time, asymmetrical landing mechanics do not and should be addressed clinically.
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Yang XG, Feng JT, He X, Wang F, Hu YC. The effect of knee bracing on the knee function and stability following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res 2019; 105:1107-1114. [PMID: 31279767 DOI: 10.1016/j.otsr.2019.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee brace has been commonly used as a device to protect the graft after reconstruction of anterior cruciate ligament (ACL). Studies have focused on the effects of braces after ACL reconstruction, and controversial results were reported. The current meta-analysis was conducted to identify whether knee braces could provide superior clinical outcomes on knee functional scores and stability evaluations. HYPOTHESIS Knee braces could not provide superior clinical outcomes on knee functional scores and stability evaluations. MATERIALS AND METHODS Two reviewers independently retrieved the literature on PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Data related to the knee functional scores and stability evaluations, including International Knee Documentation Committee (IKDC) evaluation, Lachman test, manual anterior drawer test, single leg hop test, pivot shift test, side-to-side difference, Lysholm score and Tegner score, were extracted and pooled using meta-analysis with fixed or random- effect models when applicable. RESULTS A total of 7 studies with 440 participants were finally included. The IKDC objective score was pooled using the odds ratio (OR) as effect size, which was demonstrated to be non-significantly different between the brace and no brace groups. All of the other clinical outcomes, including Lysholm score, Tegner score, side-to-side difference, single-leg hop test and VAS pain score, were pooled using the standard mean difference (SMD) as effect size. At final follow up, the aforementioned clinical outcomes were demonstrated to be similar between the brace and non-brace groups. DISCUSSION Knee bracing does not appear to improve the clinical outcomes on the function and stability for ACL-reconstructed knees. Thus, bracing for patients treated with ACL reconstruction should not be recommended routinely. LEVEL OF EVIDENCE I, Meta-analysis.
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Affiliation(s)
- Xiong-Gang Yang
- Graduate School, Tianjin Medical University, 300070 Tianjin, China
| | - Jiang-Tao Feng
- Graduate School, Tianjin Medical University, 300070 Tianjin, China
| | - Xin He
- Department of Orthopedic Oncology, Tianjin Hospital, 300211 Tianjin, China
| | - Feng Wang
- Graduate School, Tianjin Medical University, 300070 Tianjin, China
| | - Yong-Cheng Hu
- Department of Orthopedic Oncology, Tianjin Hospital, 300211 Tianjin, China.
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10
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Do Knee Braces Prevent Ski Knee Injuries? Asian J Sports Med 2017. [DOI: 10.5812/asjsm.58678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Greenfield JRJ, Hwang HF, Davies C, McDaid AJ. Soft-stop knee brace for rehabilitation from ligament injuries: Design and pilot trial. IEEE Int Conf Rehabil Robot 2017; 2017:352-357. [PMID: 28813844 DOI: 10.1109/icorr.2017.8009272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ligaments within the human knee are commonly torn or injured as a result of sports that involve sharp direction changes, pivoting and landing. For this reason, athletes are often side-lined from their respective sports for up to 18 months after injury to rehabilitate. As part of the rehabilitation process, knee braces are often prescribed in an attempt to decrease the recovery period of the injured individual by restraining and minimizing the motion at the knee. However, the true efficacy of knee bracing is yet to be fully evaluated as studies show mixed results to whether braces actually decrease the rehabilitation period for patients. This paper describes the design and pilot trials of a simple but novel knee brace design that aims to actively aid the rehabilitation of the knee from ligament injuries, primarily the anterior cruciate ligament (ACL). The newly developed knee brace uses an angle locking mechanism with dampers to control both the range of motion of the knee joint and the resistance applied to the knee joint at the limits of extension. Using finite element analysis, these dampers were designed help build muscle strength during everyday use of the knee brace and to reduce the 'jarring effect' which causes significant pain and risk to patients using current knee brace designs. Through providing these features, this new knee brace design has the potential to help improve the extent and speed of recovery for ACL impaired patients.
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Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Am Acad Orthop Surg 2017; 25:239-249. [PMID: 28195986 DOI: 10.5435/jaaos-d-15-00710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the current literature on the use of functional knee braces after anterior cruciate ligament (ACL) reconstruction with respect to clinical and in vivo biomechanical data. METHODS A systematic search of both the PubMed and Embase databases was performed to identify all studies that reported clinical and/or in vivo biomechanical results of functional bracing versus nonbracing after ACL reconstruction. Extracted data included study design, surgical reconstruction techniques, postoperative rehabilitation protocols, objective outcomes, and subjective outcomes scores. The in vivo biomechanical data collected included kinematics, strength, function, and proprioception. Subjective clinical outcomes scores were collected when available. Quality appraisal analyses were performed using the Cochrane Collaboration tools for randomized and nonrandomized trials to aid in data interpretation. RESULTS Fifteen studies met the selection criteria (including 3 randomized trials [level II], 11 nonrandomized trials [level II], and 1 retrospective comparative study [level III]), with follow-up intervals ranging from 3 to 48 months. Most studies were designed to compare the effects of functional bracing versus nonbracing on subjective and objective results in patients who underwent previous primary ACL reconstruction. Functional bracing significantly improved kinematics of the knee joint and improved gait kinetics, although functional bracing may decrease quadriceps activation without affecting functional tests, range of motion, and proprioception. Four studies reported no differences in subjective outcomes scores with brace use; however, one study reported increased patient confidence with brace use, whereas another study reported decreased pain and quicker return to work when the brace was not used. CONCLUSIONS The effectiveness of postoperative functional bracing following ACL reconstruction remains elusive. Some data suggest that functional bracing may have some benefit with regard to in vivo knee kinematics and may offer increased protection of the implanted graft after ACL reconstruction without sacrificing function, range of motion, or proprioception. However, limited evidence exists supporting the use of routine functional bracing to decrease the rate of reinjury after ACL reconstruction.
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Giotis D, Paschos NK, Zampeli F, Pappas E, Mitsionis G, Georgoulis AD. Bracing can partially limit tibial rotation during stressful activities after anterior crucial ligament reconstruction with a hamstring graft. Orthop Traumatol Surg Res 2016; 102:601-6. [PMID: 27234872 DOI: 10.1016/j.otsr.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/26/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hamstring graft has substantial differences with BPTB graft regarding initial mechanical strength, healing sequence, and vascularization, which may imply that a different approach during rehabilitation period is required. The purpose of this study was to investigate the influence of knee bracing on tibial rotation in ACL-reconstructed patients with a hamstring autograft during high loading activities. The hypothesis was that there would be a decrease in tibial rotation in the ACL-reconstructed braced knee as compared to the unbraced knee. METHODS Twenty male patients having undergone unilateral ACL reconstruction with a semitendinosus/gracilis autograft were assessed. Kinematic data were collected with an eight-camera optoelectronic system during two stressful tasks: (1) descending from a stair and subsequent pivoting; and (2) landing from a platform and subsequent pivoting. In each patient, three different experimental conditions were evaluated: (A) wearing a prophylactic brace (braced condition); (B) wearing a patellofemoral brace (sleeved condition); (C) without brace (unbraced condition). The intact knee without brace served as a control. RESULTS Tibial rotation was significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (P≤0.01 for both tasks). Presence of a brace or sleeve resulted in lower tibial rotation than in the unbraced condition (p=0.003 for descending/pivot and P=0.0004 for landing/pivot). The braced condition resulted in lower rotation than the sleeved condition for descending/pivoting (P=0.031) while no differences were found for landing/pivoting (P=0.230). CONCLUSION Knee bracing limited the excessive tibial rotation during pivoting under high loading activities in ACL-reconstructed knees with a hamstring graft. This partial restoration of normal kinematics may have a potential beneficial effect in patients recovering from ACL reconstruction with a hamstring autograft. LEVEL OF EVIDENCE Level III, case-control therapeutic study.
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Affiliation(s)
- D Giotis
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
| | - N K Paschos
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece; Department of biomedical engineering, university of California, One Shields Avenue, Davis, 95616, CA, USA.
| | - F Zampeli
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
| | - E Pappas
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece; Discipline of physiotherapy, faculty of health sciences, university of Sydney, Sydney, NSW, Australia; Department of physical therapy, Long Island university, Brooklyn campus, Brooklyn, New York, USA
| | - G Mitsionis
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
| | - A D Georgoulis
- Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
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Single-leg postural stability deficits following anterior cruciate ligament reconstruction in pediatric and adolescent athletes. J Pediatr Orthop B 2016; 25:338-42. [PMID: 26863483 DOI: 10.1097/bpb.0000000000000276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objective of this study was to compare the postural stability of pediatric and adolescent athletes without anterior cruciate ligament injury with those who underwent anterior cruciate reconstruction (ACLR). Postural stability ratings derived from a video-force plate system during the three stances of the modified Balance Error Scoring System were collected from pediatric and adolescent athletes who underwent ACLR (N=24; mean 1.2 years after surgery) and from uninjured controls (N=479). The postural control rating was calculated as the mean of the displacement and variance of the torso and center of pressure data, normalized on a scale from 0 to 100. A higher rating indicates greater postural stability. Participants who underwent ACLR showed lower postural stability ratings during single-leg stance compared with uninjured controls (40.0 vs. 48.7; P=0.037). ACLR is associated with deficits in postural stability.
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Rodríguez-Merchán EC. Knee Bracing After Anterior Cruciate Ligament Reconstruction. Orthopedics 2016; 39:e602-e609. [PMID: 27203412 DOI: 10.3928/01477447-20160513-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 02/26/2015] [Indexed: 02/03/2023]
Abstract
Although some articles in the literature are in favor of the use of a postoperative brace after anterior cruciate ligament (ACL) reconstruction, this review found that several systematic reviews and other reports on the topic do not support the use of a postoperative brace after ACL reconstruction. There is no scientific evidence so far to support the routine use of a functional knee brace following a successful ACL reconstruction in the postoperative course. Most authors believe that bracing is not necessary. There is insufficient evidence to inform current practice. Good-quality randomized trials are required to remedy this situation. Future studies should better define the role of a brace following ACL surgery. A search of MEDLINE for articles published between January 1, 1995, and September 30, 2013, was performed. Key search terms used were ACL reconstruction and knee brace. Ninety-one articles were found, but only 28 focused on the subject of bracing after ACL reconstruction and were selected for this review. Several systematic reviews and randomized, controlled trials on the topic do not recommend the use of postoperative brace after ACL reconstruction. Postoperative bracing after ACL reconstruction does not seem to help with pain, function, rehabilitation, and stability. The literature does not support the use of a postoperative brace following ACL reconstruction. [Orthopedics. 2016; 39(4):e602-e609.].
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Abstract
In athletes, significant advances in anterior cruciate ligament reconstruction techniques and rehabilitation have led to improved surgical outcomes and increased expectations for return to play. Although an expeditious return to sport has become an achievable and often realistic goal, the factors that most influence safe, timely, and successful return to play remain unknown. The literature offers mainly anecdotal evidence to guide the team physician in the decision-making process, with a paucity of criteria and consensus guidelines available to help determine return to sport. Attempts have been made to introduce criteria-based progression in the rehabilitation process, but validation of subjective and objective criteria has been difficult. Nevertheless, several pertinent factors in the preoperative, intraoperative, and postoperative periods may affect return to play following anterior cruciate ligament reconstruction. Further research is warranted to validate reliable, consensus guidelines with objective criteria to facilitate the return to play process.
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Mahnik A, Mahnik S, Dimnjakovic D, Curic S, Smoljanovic T, Bojanic I. Current practice variations in the management of anterior cruciate ligament injuries in Croatia. World J Orthop 2013; 4:309-315. [PMID: 24147268 PMCID: PMC3801252 DOI: 10.5312/wjo.v4.i4.309] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/18/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia.
METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire.
RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation.
CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.
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Davis AG, Pietrosimone BG, Ingersoll CD, Pugh K, Hart JM. Quadriceps function after exercise in patients with anterior cruciate ligament-reconstructed knees wearing knee braces. J Athl Train 2012; 46:615-20. [PMID: 22488186 DOI: 10.4085/1062-6050-46.6.615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Knee braces and neoprene sleeves are commonly worn by people with anterior cruciate ligament reconstructions (ACLRs) during athletic activity. How knee braces and sleeves affect muscle activation in people with ACLRs is unclear. PURPOSE To determine the effects of knee braces and neoprene knee sleeves on the quadriceps central activation ratio (CAR) before and after aerobic exercise in people with ACLRs. DESIGN Crossover study. PATIENTS OR OTHER PARTICIPANTS Fourteen people with a history of ACLR (9 women, 5 men: age = 23.61 ± 4.44 years, height = 174.09 ± 9.82 cm, mass = 75.35 ± 17.48 kg, months since ACLR = 40.62 ± 20.41). INTERVENTION(S) During each of 3 sessions, participants performed a standardized aerobic exercise protocol on a treadmill. The independent variables were condition (brace, sleeve, or control) and time (baseline, pre-exercise with brace, postexercise with brace, postexercise without brace). MAIN OUTCOME MEASURE(S) Normalized torque measured during a maximal voluntary isometric contraction (T(MVIC)) and CAR were measured by a blinded assessor using the superimposed burst technique. The CAR was expressed as a percentage of full muscle activation. The quadriceps CAR and T(MVIC) were measured 4 times during each session: baseline, pre-exercise with brace, postexercise with brace, and postexercise without brace. RESULTS Immediately after the application of the knee brace, T(MVIC) decreased (P = .01), but no differences between bracing conditions were observed. We noted reduced T(MVIC) and CAR (P < .001) after exercise, both with and without the brace. No differences were seen between bracing conditions after aerobic exercise. CONCLUSIONS The decrease in T(MVIC) immediately after brace application was not accompanied by differences between bracing conditions. Wearing a knee brace or neoprene sleeve did not seem to affect the deterioration of quadriceps function after aerobic exercise.
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Survey study of members of the Canadian Orthopaedic Association on the natural history and treatment of anterior cruciate ligament injury. Clin J Sport Med 2011; 21:249-58. [PMID: 21519299 DOI: 10.1097/jsm.0b013e318219a649] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe current preferences and opinions of members of the Canadian Orthopaedic Association (COA) pertaining to anterior cruciate ligament (ACL) reconstruction. DESIGN Survey study. PARTICIPANTS All orthopedic surgeon members of the COA residing in Canada were invited to participate. MAIN OUTCOME MEASURES The primary measure was a survey completed via an Internet-based survey manager. It was composed of 30 questions on the natural history of ACL-injured knees, and surgical and postsurgical treatment choices. RESULTS Two hundred eighty-three surgeons (50%) responded to the survey. One hundred forty-four performed ACL reconstruction in the past year. In terms of natural history, the only area of agreement was that hamstring and quadricep strength affects function in ACL-deficient knees (92%). A majority of surgeons indicated preference for hamstring autograft (73%), transtibial versus anteromedial portal for establishment of the femoral tunnel (70% vs 28%), and promotion of full weight bearing and range of motion immediately after surgery (72% and 75%, respectively). The most frequent surgeon-reported complication was tunnel widening (10%). A greater proportion of high-volume surgeons permitted earlier return to sport (P < 0.008). CONCLUSIONS In the rapidly evolving area of ACL reconstruction, no recent surveys of opinions and preferences of Canadian orthopedic surgeons have been published. In addition to providing information from a Canadian perspective, the findings from this study will allow surgeons to evaluate a range of treatment decisions based on the general opinions of their colleagues and also highlights areas of dissimilarity that can be targeted for more extensive research.
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Houck JR, Duncan A, De Haven KE. Comparison of frontal plane trunk kinematics and hip and knee moments during anticipated and unanticipated walking and side step cutting tasks. Gait Posture 2006; 24:314-22. [PMID: 16293416 DOI: 10.1016/j.gaitpost.2005.10.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 09/25/2005] [Accepted: 10/09/2005] [Indexed: 02/02/2023]
Abstract
BACKGROUND Frontal plane trunk and lower extremity adjustments during unanticipated tasks are hypothesized to influence hip and knee neuromuscular control, and therefore, contribute to anterior cruciate ligament (ACL) injury risk. The aims of this study were to examine frontal plane trunk/hip kinematics and hip and knee moments (measures of neuromuscular control) during unanticipated straight and side step cut tasks. METHODS Kinematic and kinetic variables were collected while subjects performed two anticipated tasks, including walking straight (ST) and side step cutting (SS), and two unanticipated tasks (STU and SSU). Foot placement, thorax-pelvis-hip kinematic variables and hip and knee moments were calculated over the first 30% of stance. FINDINGS Hip abduction angles and knee moments were significantly affected by task and anticipation. Hip abduction angles decreased, by 4.0-7.6 degrees , when comparing the SSU task to the ST, STU and SS tasks. The hip abduction angles were associated with foot placement and lateral trunk orientation. INTERPRETATION Hip abduction angles and foot placement, not lateral trunk flexion influence trunk orientation. Anticipation influences hip and knee neuromuscular control and therefore may guide the development of ACL prevention strategies.
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Affiliation(s)
- Jeff R Houck
- Ithaca College-Rochester, 300 East River Road, Suite 1-101, University of Rochester-South Campus, Rochester, NY 14623, USA.
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Sterett WI, Briggs KK, Farley T, Steadman JR. Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction: a prospective cohort study. Am J Sports Med 2006; 34:1581-5. [PMID: 16870823 DOI: 10.1177/0363546506289883] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of knee bracing in anterior cruciate ligament reconstructions is controversial. HYPOTHESIS Functional bracing will have an effect on subsequent knee injury in skiers with anterior cruciate ligament reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From 1991 to 1997, 11606 skiers at a major destination ski resort underwent preseason knee screening. The anterior cruciate ligament-reconstructed group consisted of 820 skiers who had had an anterior cruciate ligament reconstruction 2 years or more earlier. Of these, 257 skiers selected the use of functional knee brace during skiing. The dependent variable was subsequent knee injury, identified via workers' compensation records. Covariates included age, gender, ski occupation, Lachman grade, pivot-shift grade, KT-1000 arthrometer manual maximum displacement, and use of a functional brace. Univariate and multivariate risk factors for subsequent knee injury were determined. RESULTS In this study, 257 skier-employees with anterior cruciate ligament reconstruction wore braces and 563 skier-employees with anterior cruciate ligament reconstruction did not. Braced skiers had significantly higher preseason rates of grade II or higher Lachman and pivot-shift tests (braced, 29% and 22%, respectively; nonbraced, 11% and 10%, respectively; P < .05). Sixty-one subsequent knee injuries were identified, 51 (8.9 injuries/100 knees/ski season) in the nonbraced group and 10 (4.0 injuries/100 knees/ski season) in the braced group (P = .009). Nonbraced skiers were 2.74 times more likely to suffer subsequent injury than were braced skiers (odds ratio, 2.74 [confidence interval, 1.2-4.9]). Logistic regression modeling identified nonbracing as a significant independent multivariate risk factor for subsequent knee injury in the high-demand skiers with anterior cruciate ligament reconstruction. CONCLUSION Because of the increased risk of subsequent knee injury in nonbraced skiers, the authors recommend functional bracing for skiers with anterior cruciate ligament reconstruction. Whether the protective effect of functional bracing can be extrapolated to other high-demand patients is yet to be determined.
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Temporal Influences of Functional Knee Bracing on Torque Production of the Lower Extremity. J Sport Rehabil 2006. [DOI: 10.1123/jsr.15.3.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context:Functional knee braces (FKB) are used prophylactically and in rehabilitation to aide in the functional stability of the knee.Objective:To determine if alterations in select lower extremity moments persist throughout a one hour period in healthy individuals.Design:2X5 repeated measures design.Setting:Biomechanics Laboratory.Subjects:Twenty subjects (14 male and 6 female, mean age 26.5±7 yrs; height 172.4±13 cm; weight 78.6±9 kg), separated into braced (B) and no brace (NB) groups.Intervention:A one-hour exercise program divided into three 20 minute increments.Main Outcome Measures:Synchronized three-dimensional kinematic and kinetic data were collected at 20-minute increments to assess the effect of the FKB on select lower extremity moments and vertical ground reaction forces.Results:Increase in hip moment and a decrease in knee moment were noted immediately after brace application and appeared to persist throughout a one hour bout of exercise.Conclusions:The FKB and the exercise intervention caused decreases in knee joint moments and increases in hip joint moments.
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Lu TW, Lin HC, Hsu HC. Influence of functional bracing on the kinetics of anterior cruciate ligament-injured knees during level walking. Clin Biomech (Bristol, Avon) 2006; 21:517-24. [PMID: 16494979 DOI: 10.1016/j.clinbiomech.2005.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Revised: 12/22/2005] [Accepted: 12/29/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Use of functional knee braces has been suggested to provide protection and to improve kinetic performance of the knee in anterior cruciate ligament-injured patients. However, the efficacy of knee bracing in achieving these goals is still controversial. The purpose of this study was to examine the immediate effects of functional bracing on the three-dimensional kinetics of the knee in individuals with anterior cruciate ligament injuries during level walking. METHODS Fifteen anterior cruciate ligament-deficient and 15 anterior cruciate ligament-reconstructed subjects were each fitted with a DonJoy Goldpoint brace and walked at a self-selected pace, first without and then with the brace. Kinematic and kinetic data were measured and three-dimensional joint moments and angular impulses at the knee were calculated and compared between bracing conditions and between limbs. FINDINGS Functional knee bracing did not significantly affect the kinetics of the unaffected knees for either group. Bracing significantly increased the peak abductor moments in anterior cruciate ligament-deficient knees and reduced the bilateral kinetic asymmetry in the coronal plane. For the anterior cruciate ligament-reconstructed group, bracing increased peak moments and impulses of the abductors and extensors. It also reduced bilateral kinetic asymmetry in the sagittal and coronal planes. INTERPRETATION Effects of the knee brace were apparent in the coronal plane for both anterior cruciate ligament-deficient and anterior cruciate ligament-reconstructed patients, and in the sagittal plane for anterior cruciate ligament-reconstructed patients. Functional bracing can be recommended for anterior cruciate ligament-reconstructed patients to assist in achieving better bilateral kinetic symmetry during gait. For anterior cruciate ligament-deficient patients, apart from bracing, additional emphasis on the rehabilitative training for better kinetic knee performance in the sagittal plane is needed.
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Affiliation(s)
- Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, 1, Sec. 1, Jen-Ai Road, Taipei 100, Taiwan, ROC.
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Swirtun LR, Jansson A, Renström P. The effects of a functional knee brace during early treatment of patients with a nonoperated acute anterior cruciate ligament tear: a prospective randomized study. Clin J Sport Med 2005; 15:299-304. [PMID: 16162987 DOI: 10.1097/01.jsm.0000180018.14394.7e] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of a functional knee brace on nonoperated acute anterior cruciate ligament (ACL)-deficient patients. DESIGN : Prospective randomized clinical trial. SETTING University clinic. PATIENTS Ninety-five patients (18-50 years old) with an acute ACL tear were included in the present study. The subjects were randomized to either brace group, treated with functional bracing from the first testing session (<5 weeks postinjury) to 12 weeks postinjury or a control group, treated without bracing. The patients were followed for 6 months. Twenty-one subjects were excluded due to the following exclusion criteria: partial rupture or articular cartilage injury shown on MRI or with arthroscopy, or other injuries that negatively affected rehabilitation, or dropped out due to surgery (n = 22), or personal reasons (n = 10). Forty-two patients remained in the study, 22 in the brace group and 20 in the control group. OUTCOME MEASUREMENTS Visual analogue scale, Knee Osteoarthritis Outcome Score, Cincinnati knee score, a brace evaluation form, and muscle peak torque. RESULTS When using the brace the subjects in the brace group experienced less (P = 0.047) sense of instability, evaluated with visual analogue scale, than the control group. However, bracing had no effect on any of the variables in Knee Osteoarthritis Outcome Score or Cincinnati knee score and no effect on quadriceps or hamstring muscle peak torque. Subjectively, the brace group experienced a positive effect of the brace on rehabilitation. CONCLUSIONS Nonoperated acute ACL-deficient patients experienced a positive effect of the brace regarding sense of instability and rehabilitation. However, these findings were not supported by objective outcomes.
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Affiliation(s)
- Linda R Swirtun
- Section of Sports Medicine, Division of Surgical Sciences Karolinska Institutet, Stockholm, Sweden.
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Cascio BM, Culp L, Cosgarea AJ. Return to play after anterior cruciate ligament reconstruction. Clin Sports Med 2004; 23:395-408, ix. [PMID: 15262378 DOI: 10.1016/j.csm.2004.03.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of knee ligament reconstruction is to return the athlete to the previous level of function as quickly and as safely as possible. The appropriate level of aggressiveness in returning the athlete to sport remains controversial. Information in the literature regarding safe return to play has been dominated by the anterior cruciate ligament (ACL) reconstruction literature. The basic concepts that hold true for returning the ACL-reconstructed athlete to play can be generalized to injuries treated nonoperatively as well. This article presents a review of the principles of rehabilitation following knee ligament reconstruction, with an emphasis on criteria for return to play.
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Affiliation(s)
- Brett M Cascio
- Department of Orthopaedic Surgery, Division of Sports Medicine, Johns Hopkins University, 10754 Falls Road, Suite 215, Lutherville, MD 21093, USA
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Li AY, Ng GY. Overview of Anterior Cruciate Ligament Rehabilitation and its Evolution in Hong Kong in the Past 8 Years. Hong Kong Physiother J 2004. [DOI: 10.1016/s1013-7025(09)70045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lawhorn KW, Howell SM. Scientific justification and technique for anterior cruciate ligament reconstruction using autogenous and allogeneic soft-tissue grafts. Orthop Clin North Am 2003; 34:19-30. [PMID: 12735198 DOI: 10.1016/s0030-5898(02)00029-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The DLSTG is the strongest and stiffest autogenous graft source available for reconstruction of the torn anterior cruciate ligament. Harvest morbidity is low compared with other autogenous graft sources, such as the patellar bone-tendon-bone graft. Soft-tissue allografts provide an excellent alternative for patients requiring revision surgery or for patients who want to avoid any morbidity associated with autogenous graft harvest. Successful use of any soft-tissue graft source, however, relies on precise placement of the tibial and femoral tunnels to prevent roof and PCL impingement and to restore tensile behavior in the graft tissue similar to the native ACL. The use of high-strength, high-stiffness fixation devices that secure the graft at the end of the tunnel promote tendon tunnel healing, restore stability without high graft tensioning, and allow safe, aggressive rehabilitation. The Bone Mulch Screw/WasherLoc screw system provides the surgeon with a consistent, reproducible technique that restores stability and function to the ACL-deficient knee using a soft-tissue graft in both males and females.
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Affiliation(s)
- Keith W Lawhorn
- Uniformed Services, University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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Birmingham TB, Kramer JF, Kirkley A. Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 2002; 83:1472-5. [PMID: 12370890 DOI: 10.1053/apmr.2002.35093] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the effect of a knee brace on knee flexion and extension muscular strength of patients after anterior cruciate ligament (ACL) reconstruction and to evaluate whether the effect of the brace depends on patient symptoms and muscular strength. DESIGN Repeated measures. SETTING A university-based outpatient orthopedic clinic and musculoskeletal assessment laboratory. PARTICIPANTS Twenty-seven patients (14 women, 13 men; mean age, 28+/-11 y) having undergone arthroscopically assisted ACL reconstruction by using a semitendinosus and gracilis autograft. INTERVENTION A custom-fit ACL functional knee brace. MAIN OUTCOME MEASURES The brace effect was calculated as the change in peak torque observed with the brace, expressed as a percentage of peak torque observed without the brace, during isokinetic concentric knee flexion and extension movements performed at 90 degrees /s. Patient symptoms were quantified by using a disease-specific health-related quality of life questionnaire. RESULTS Knee flexion strength decreased significantly with the brace (mean brace effect=-7.3%, P<.05). The brace effect during knee flexion varied considerably (-52% to 47%) and was significantly related to peak torque observed without the brace (r=-.50, P<.01). All other comparisons and correlations were not significant. CONCLUSIONS These findings suggest that brace effects depend on patient strength. A brace may inhibit knee flexion strength of stronger patients, yet result in no change or even improvements in strength of weaker patients. Future research is required to further elucidate which patients may derive most benefit or detriment from bracing.
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Affiliation(s)
- Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ont, Canada.
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Lam RY, Ng GY, Chien EP. Does wearing a functional knee brace affect hamstring reflex time in subjects with anterior cruciate ligament deficiency during muscle fatigue? Arch Phys Med Rehabil 2002; 83:1009-12. [PMID: 12098163 DOI: 10.1053/apmr.2002.33231] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effects of wearing a functional knee brace and muscle fatigue on hamstring reflex time in subjects with anterior cruciate ligament (ACL) deficiency. DESIGN Repeated-measures clinical trial. SETTING Outpatient physical therapy department. PARTICIPANTS Sixteen subjects with ACL deficiency. INTERVENTION Subjects tested with and without a functional knee brace before and after an exercise protocol designed to fatigue the knee muscles. MAIN OUTCOME MEASURE Latency of hamstring reflex muscle activity after sudden perturbation of the knee. RESULTS Wearing a knee brace shortened the hamstring reflex latency regardless of fatigue (F(1,15)=20.62, P<.001). Muscle fatigue lengthened the hamstring reflex time regardless of the bracing condition (F(1,15)=7.57, P<.015). CONCLUSION Wearing a functional knee brace facilitated hamstring muscle reflex, but muscle fatigue lengthened the hamstring reflex latency. Subjects with ACL deficiency should not rely on the knee brace to facilitate hamstring reflex for joint protection during prolonged sporting activities when muscles are fatigued.
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Affiliation(s)
- Rita Y Lam
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
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Ng G, Mak A, Wu G. The authors reply. Arch Phys Med Rehabil 2001. [DOI: 10.1053/apmr.2001.24895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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