Functional Knee Brace vs. Neoprene Sleeve After ACL Reconstruction
Clinical Pearl: Not all patients recovering from ACL reconstruction require functional knee braces. The type of bracing,
whether a simple neoprene sleeve or functional brace, should be considered on a case by case basis.
For many years, functional knee braces have been proposed to improve outcomes after reconstructive ACL surgery.
Study results are inconsistent and their applicability to functional activities and overall outcomes has been questioned. Further,
simpler braces, such as neoprene sleeves, are readily available, and also appear to provide proprioceptive benefits at a much
lower cost to the patient or health care system. A recent membership survey of the American Academy of Orthopedic
Surgeons (AAOS) revealed that 62.9% of surgeons recommend functional bracing during sports participation after ACL
reconstruction. The recent AAOS position statement on the use of knee braces suggests that they do not appear to be required
postoperatively, although there may be a subgroup of patients that may benefit (such as those with weakened tissue or
suboptimal graft fixation). This study attempted to provide some clarity to this issue by comparing outcomes in quality of life
and knee function between those using a functional knee brace and those using a neoprene sleeve during physical activities
after ACL reconstruction.
This study was a 2-group, parallel-design RCT conducted in a tertiary care sports medicine clinic. Subjects were
between 14-45 years of age (average: ~ 27), and had undergone 4-strand hamstring tendon ACL reconstruction. Exclusion
criteria included:
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>2 years since initial injury
concomitant PCL, MCL, or chondral injury requiring treatment (note: those with medial meniscus injuries
were included)
severe degenerative joint disease
known metabolic bone, collagen, or neoplastic disease
femoral, tibial, or patellar fracture
unstable contralateral knee
living > 300 km away from the clinic
150 patients were randomized into two intervention groups at their 6-week postoperative visit: First Group: Functional
Brace: providing a 4-point leverage system using cuffs and straps to resist anterior tibial translation was provided to patients
(DonJoy Legend, DJO Inc., Vista California) and set to limit knee extension to 10° from full range. Second Group: Neoprene
Sleeve: featured an open patella, and is purported by the manufacturer to provide even compression while allowing unrestricted
movement (Neoprene Knee Sleeve, DJO Inc., Vista California). Subjects were instructed to wear the brace or sleeve during
participation in all physical activities. Brace and sleeve use was tracked at 6 and 12 months postoperatively using single-item
VAS (100mm) scale responses to a frequency-of-use questionnaire.
This study suggests that using a functional knee brace during rehabilitation and return to sport does not result in
superior results when compared to a simpler, less expensive neoprene sleeve, in patients who have undergone ACL graft
reconstruction (note: this study did lack a control group with a no brace/sleeve condition). The subjective superiority of the
brace as reported by patients was small, and likely not clinically significant. Further, some experts have suggested that a
functional brace may provide a false sense of security to patients, hence having potential negative consequences (this may
explain the variability in surgeon surveys noted above). The results of this study can neither support, nor refute this thought.
Some would also question the applicability of this study to custom-made functional braces (the one used in this study came in
different sizes, but is available off-the-shelf). Laboratory studies to date however, have not found significant advantages with
custom braces.
[Birmingham TB et al. Functional Knee Brace vs. Neoprene Sleeve After ACL Reconstruction. American Journal of Sports
Medicine. 2008; 36(4): 648-655.]