Clinical Question: Does bracing after repair of acute anterior cruciate ligament (ACL) injuries improve functional outcomes?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (nonblinded)

Allocation: Uncertain

Synopsis: In this study, patients who had complete tears of the ACL and were operated on within eight weeks of injury were assigned randomly to receive postoperative bracing (n = 47) or no bracing (n = 48). Although the authors described their allocation process, they did not describe whether the process was masked.

To minimize the surgeons' potential effect on functional outcomes, they all agreed to use the same surgical technique. The rehabilitation regimen was identical for all patients. All patients' knees were immobilized for the first three weeks after surgery. For those wearing braces, the braces were adjusted to allow partial motion from three to six weeks after surgery. After six weeks, these patients were fitted with an off-the-shelf functional knee brace, which they agreed to wear daily for six months and during all rigorous activities for at least one year. For the patients who were not braced, the knee immobilizer was removed three weeks after surgery. The authors did not report whether they used intention-to-treat analysis or if the outcomes were assessed by persons unaware of the treatment assignment.

The study began with 100 patients and five dropped out. The authors did not account for these patients in their analysis. Also, they did not define what their main outcome was and did not define several key outcomes, such as what constituted a “significant reinjury.” They evaluated the patients at least two years after surgery. Only one person did not return to the presurgery level of function. Two braced and three nonbraced patients sustained significant reinjuries to their knees. There was no difference in range of motion or strength between the groups. Because this study did not include enough patients to determine with certainty that bracing causes no difference, a systematic review is needed.

Bottom Line: In this study, the use of bracing following the surgical repair of acutely torn ACLs does not prevent reinjury or speed the return to original level of activity. (Level of Evidence: 2b–)