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Weak Knees: To Brace or Not to Brace

May 17, 2006 10:38 AM

By Jim Brown, Ph.D., Executive Editor, Sports Performance Journal (www.athletesperformance.com), Author, Tennis: Steps to Success

Tennis players and other serious athletes put a tremendous amount of stress on their knees. Some of them sustain knee injuries and wear knee braces afterward, while others are faced with the question of whether they should use knee braces to prevent injuries.

To help athletes, coaches, parents, and sports medicine personnel determine if knee braces are appropriate, the American Academy of Orthopaedic Surgeons (AAOS) has classified knee braces into four categories and given position statements regarding their use. Three of the statements that could apply to tennis players follow the category descriptions.

** Prophylactic knee braces are designed to prevent or reduce the severity of knee injuries.

** Rehabilitative knee braces are designed to allow protected motion of injured knees or knees that have been treated operatively.

** Functional knee braces are designed to (a) provide stability for the ACL or other ligament deficient knee, and (b) provide protection for the ACL or other ligaments after repairs or reconstructions.

** Unloader/offloader braces are designed to provide pain relief in arthritic knees.

Statement #1
After ACL reconstruction, there may be a role for rehabilitation braces used in the early post-surgical phase, but functional braces used later during recovery appear to provide no added protection to the knee following reconstruction.

Types of braces other than prophylactic knee braces have different structural designs and have been developed to help treat specific problems stemming from injury or disease. Rehabilitative knee braces have been designed to provide a compromise between protection and motion. There is some evidence that use of these braces in the initial post surgical period may improve early functional outcomes. The majority of scientific studies show no difference in final outcomes of anterior cruciate reconstructed knees, whether a brace is worn or not. The overall long-term outcome in all studies reviewed was good. Thus, it does not appear that a brace is needed to support or protect a reconstruction in a well done surgical procedure.

Statement #2
While functional knee braces offer limited control of functional instability symptoms in patients with anterior cruciate ligament deficient knees, they have not been shown to prevent the development of meniscal tears and articular cartilage wear.

Functional knee braces aid in the control of unstable knees. Some of the currently available braces are very effective in controlling abnormal motions under low load conditions but not under high loading conditions that occur during many athletic activities. Most studies designed to test whether functional knee braces protect against the knee "giving way" have demonstrated some beneficial effect of the brace. However, the patient and the physician must guard against a false sense of security evoked by the use of such a brace. Functional knee braces do not restore normal knee stability under high forces related to certain activities. Furthermore, some studies suggest that functional braces negatively affect some aspects of athletic performance. Given the generally high surgical success rates, there is no scientific evidence to date to support the use of a functional knee brace following a successful ACL reconstruction.

Statement #3
Some unloader braces may provide significant reduction in pain when properly fitted in selected patients with osteoarthritis of the knee.

Patients with osteoarthritis of the knee develop increased pain in the affected compartment due to increased mechanical loading. Unloader/offloader braces are designed and constructed to reduce uneven loading. There is strong evidence demonstrating reduction in adduction movement in varus (bow-legged) knees when the appropriate unloader brace is used. Clinical studies have shown improved pain and function in patients with medial compartment osteoarthritis using some unloader braces. Patients with advanced osteoarthritis or severe varus or valgus (knock-kneed) malalignment would not likely benefit from bracing.

© 2006 HMS Publishing, Inc.
Jim Brown will be contributing new content to this site on a monthly basis. If you have a question for Dr. Brown please feel free to email him at
sportsmed@mindspring.com.

 

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