Many patients ask if they need to wear a brace for sports after ACL surgery. This type of brace is often referred to as an ACL functional brace. These types of braces can be worn during higher level activities such as cutting or pivoting without being too restrictive on the patient.
Some surgeons recommend functional bracing for their patients when returning to sports, while others feel it is unnecessary. This discrepancy likely arises from the conflicting literature out there.
Biomechanically, the ACL functional brace can help protect against excessive rotational forces. In terms of anterior translation, the brace has been shown to reduce anterior tibial translation. In addition, some studies have shown the brace can lower ground reaction force, with others show it has no effect on it. Regarding varus and valgus forces, there are conflicting studies on how much the brace actually helps. In terms of balance, most of the studies have shown that the brace may not actually improve proprioception. In contrast, some studies show there may be a psychological benefit of bracing. Specifically, the knee brace may reduce kinesiophobia (the fear of movement).
Perhaps the most important outcome to evaluate is the clinical reinjury rate when using the functional race. Braced skiers after ACL surgery had a lower reinjury rate (4% vs 9%) but no difference in ACL revision rates. A study in military cadets showed no differences in reinjury rates. Looking at adolescent athletes, one study showed lower graft reinjury (10% vs 21%). In a large cohort of ACL patients from the MARS study group, there was no difference in graft failure. Thus, the results are mixed clinically.
In summary, there is conflicting evidence for brace wear when returning to sport after ACL injury. While biomechanically and psychologically it may offer some benefit, clinically the results are mixed. In our practice, we routinely offer our patients an ACL functional brace around the 6-12 week mark after ACL surgery with the hope of providing some level of protective effect.
If you have had ACL surgery, have a lengthy discussion with your surgeon about the pros and cons of ACL functional bracing when returning to sport.
Amit Momaya, MD is a board certified orthopedic surgeon who specializes in sports medicine. He serves as the Chief of Sports Medicine at UAB, resides on the editorial board of research journals, and takes care of several collegiate and professional teams in Alabama. This blog post is for educational purposes only. Please consult with your surgeon when deciding on an ACL functional brace when returning to sport.
