More Options After Knee Surgery

Knee injuries seem to be the price many pay for participating in the sports they love. The one I've heard most often about among my skiing set is injury to the anterior cruciate ligament (ACL). This ligament, located in the center of the knee to stabilize the joint, is indeed one of the most commonly injured. There are about 200,000 ACL injuries each year, especially in athletic people who participate in high-risk sports such as skiing, basketball, football and soccer. Often the injury is caused by twisting the knee, though it may also come from a hard slam to the side of the knee from a tackle or simply by falling on a hard surface, like ice. About half these injuries end up being treated with reconstructive surgery.

The operation involves replacing the torn ligament with a graft of tendon or ligament. The recovery period is lengthy and grueling, particularly for those who are eager to get back in the game. Returnees typically must wear a clunky and cumbersome brace often for months, but a new study shows that may not always be necessary.

EMBRACING CHANGE

According to Trevor Birmingham, PT, PhD, associate professor, School of Physical Therapy and Canada Research Chair in musculoskeletal rehabilitation at Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, most orthopedic surgeons and physical therapists currently favor bracing after ACL reconstruction. They believe that the rigid support provided by a functional knee brace protects the graft and improves both stability and function. Dr. Birmingham's research group wanted to find out if patients using the traditional bulky ACL functional knee brace had better outcomes after surgery than those using a simple (and less costly) Neoprene synthetic rubber sleeve.

The study was a randomized controlled trial involving 150 patients who had undergone ACL reconstruction. After their six-week visit, they were provided with either a typical functional knee brace or a Neoprene sleeve to wear when they returned to physical activities after the operation. All received the same standardized post-op rehabilitative physical therapy. They were followed up over a two-year period and tested on knee function and stability. "The results showed no differences between patients using the brace and those using the sleeve," Dr. Birmingham told me.

Dr. Birmingham's research group also collected information from the patients about how they felt while using the brace or the sleeve. "We did observe a higher (less than 15%) subjective rating of confidence in the knees from those using the conventional brace, at six months and 12 months," he told me, noting however that the finding is questionable given the small size of the difference. He also pointed out that increased confidence is not necessarily a good thing if it leads to less caution on the part of the wearer.

Dr. Birmingham told me that the study results were consistent with other research that has questioned the effectiveness or necessity of bracing, and with his own clinical experience with patients who do not wear a brace post-surgery. Future research should concentrate on identifying sub-groups of patients who might derive more benefit from bracing than others -- for example, those who for some reason have a weakened graft or those who participate in especially high-risk sports.

Source(s):

Trevor Birmingham, PT, PhD, associate professor, School of Physical Therapy and Canada Research Chair in musculoskeletal rehabilitation, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada.