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Cruciate - braces - issues

Submitted by admin on March 13, 2008 - 8:32pm.

 

It is in the area of functional bracing that the literature abounds with issues and controversies -

  • A study on patients with intact cruciates showed no difference in efficacy between custom and off-the-shelf braces (1).
  • Braces from different manufacturers vary considerably in the effectiveness of their restraint (2, 3).
  • Laboratory studies using models (4) and physical studies using patients performing controlled movements (5) show that functional knee braces do limit rotation and translation, but the former study showed that this protection disappears during actual use during sport.
  • There are differences in the effectiveness of braces in different positions on the field even within the same sport (6) and some studies suggest that in braced patients there is a greater likelihood of injury during sport when wearing a functional brace (7).
  • There is controversy about whether the all-important proprioception ('position sense') of the knee is improved (8) or not (9) with the use of functional braces.
  • Increased muscle fatigue is an issue in the braced leg, due to increased muscle pressure and decreased blood flow (10).
  • After anterior cruciate ligament reconstruction using identical surgical technique, the post-operative use of a functional brace seems to make no significant difference to recovery (11).
  • Some studies go so far as to claim that prophylactic and functional bracing may inhibit performance or even cause serious adverse effects (12).
  • A good review which is worth reading (incidentally published by a leading brace manufacturer) highlights that the available research is unlikely to help a doctor much in selecting an effective functional brace, and that manufacturers should assume more responsibility in the validation of both existing and future brace design (13).


References -

  1. Beynnon B.D., Pope M.H., Wertheimer C.M. et al. The effect of functional knee-braces on strain on the anterior cruciate ligament in vivo. J Bone Joint Surg. 1992, 74-A (9), 1298-1312.
  2. Wojtys E.M., Looubert P.V., Samson S.Y. et al. Use of a knee-brace for control of tibial translation and rotation. A comparison, in cadavera, of available models. J Bone Joint Surg. 1990, 72-A (9), 1323-1329.
  3. Lunsford T.R., Lunsford B.R., Greenfield J. et al. Response of eight knee orthoses to valgus, varus and axial rotation loads. Journal of Prosthetics and Orthotics. 1990, 2 (4), 274-228. (Web summary)
  4. Liu S.H., Lunsford T., Gude S. et al. Comparison of functional knee braces for control of anterior tibial displacement. Clin Orthop. 1994, 303, 203-210.
  5. Beynnon B.D., Johnson R.J. et al. The effect of functional knee bracing on the anterior cruciate ligament in the weightbearing and non-weightbearing knee. Am. Orthop, Society for Sports Med. 1997, 25 (3), 353-359.
  6. Albright J.P., Powell J.W., Smith et al. Medial collateral ligament knee sprains in college football. Soc. for Sports Med. 1994, 22 (1), 12-18.
  7. Butler P.B., Evans G.A., rose G.K. et al. A review of selected knee orthoses. British J Rheumatol. 1983, 22, 109-120.
  8. Liu S.H., Mirzian R. Current review: Functional knee bracing. Clin Orthop. 1995, 317, 273-281.
  9. Risberg M.A., Beynnon B.D., Peura G.D. Proprioception after anterior cruciate ligament reconstruction with and without bracing. Knee Surg., Sports Traumatol., Arthrosc. 1999, 7 (5), 303-309.
  10. Styf J.R., Lundin O., Gersguni D.H. Effects of a functional knee brace on leg muscle function. Am. Orthop. Soc for Sports Med. 1994, 22 (6), 830-834.
  11. McDevitt E.R., et al. Post operative braces after ACL reconstruction: A prospective randomised study, presented at the annual meeting of the American society for Sports Medicine, Sun Valley, 2000.
  12. Styf J. The effects of functional knee bracing on muscle functional performance. Sports Medicine. 1999, 28 (2), 77-81.
  13. Kartus J., Stener S., Kohler K et al. Is bracing after anterior cruciate ligament reconstruction necessary? Knee Surg., sports Traumatol., Arthrosc. 1997, 5, 157-161.
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