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Brace or No Brace After ACL-Graft? Four-Year Results of a Prospective Clinical Trial


Hermann O. Mayr, MD, Prof.
GERMANY

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Brace or No Brace After ACL-Graft? Four-Year Results of a Prospective Clinical Trial

Hermann O. Mayr, MD, Prof., GERMANY Paul Stuecken, MD, GERMANY Anke Bernstein, MD, PhD, GERMANY Philipp Niemeyer, MD, PhD, GERMANY Norbert P. Suedkamp, MD, PhD, GERMANY Amelie Stoehr, MD, GERMANY

University Hospital, Freiburg, GERMANY

2013 Congress   Paper Abstract   2013 Congress   rating (1)

 

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Instability Tears

Diagnosis Method

Physical Examination X-ray

Sports Medicine

Preventative Sports Medicine Sport Specific Injuries Evidence Based Medicine Outcome Studies

Treatment / Technique

Arthroscopy Autograft Repair / Reconstruction Single Bundle

Ligaments

ACL

Summary: In a prospective randomized trial with 52 patients using patellar tendon autograft for ACL reconstruction, divided into two equal groups and treated with or without stabilizing knee brace for 6 weeks postoperatively was shown that the aftercare with a brace brings no advantage in IKDC and KT 1000 results in comparison to the treatment without brace in the 4 year follow-up.

Question:
Can subjective and objective results after anterior cruciate ligament reconstruction using patellar tendon autografts be influenced by the postoperative use or non-use of a stabilizing knee brace?

Methods

In a prospective randomized study, a total of 64 patients were divided into two equal groups and treated with or without stabilizing knee brace for 6 weeks postoperatively. A follow-up took place after four years. Evaluated were IKDC 2000, and the KT1000 measurement, a visual analogue pain scale (VAS 0 - 10) and an x-ray examination to assess osteoarthritic changes and tunnel widening. For calculation the t-test for independent and paired samples and the Pearson chi-square test was used. Analyzes with a p-value <0.05 were considered statistically significant. The difference in the total score of the IKDC subjective represents the primary endpoint. A power calculation was performed.

Results

52 of originally 64 patients (follow-up 81%) were reexamined four years postoperatively. The results of the IKDC 2000 subjective (90.5±8,9 Brace Group, 93.2±6.1 No Brace Group), objective (Brace Group: A: 30%, B: 56%, C: 16%, No Brace Group: A: 32%, B: 48%, C: 20%) and instrumental measurement of the anteroposterior laxity with the KT1000 (Brace Group: 0.6 ±2.4 mm, No Brace Group 1.8 ±3.4 mm) showed no significant differences in the clinical outcome of the patients of both groups four years postoperative. The single-leg hop test resulted in the comparison between both groups in significantly better results (p=0.047) for the No Brace Group (95,8% ( No Brace) / 76% (Brace) =90% jump distance in comparison to the contralateral side). The VAS assessment of the No Brace group was significantly better (p=0.015) with 1.0 ± 1.2 versus 1.9 ± 1.4 at physical stress. There were no differences in osteoarthritic changes and tunnel widening.

Conclusion

The post-operative treatment after ACL replacement with a knee stabilizing brace shows no significant advantage in comparison to the treatment without a brace at the four year follow-up, so that the efficiency of this treatment should be reconsidered.