2015 ISAKOS Biennial Congress ePoster #1256

The Effect of Knee Bracing on Tibial Rotation During High Loading Activities in Anterior Cruciate Ligament Reconstructed Patients With a Bone-Patellar Tendon-Bone or a Hamstring Autograft

Dimitrios P. Giotis, MD, PhD, Ioannina GREECE
Frantzeska Zampeli, MD, PhD, Athens GREECE
Nikolaos K. Paschos, MD, PhD, Jamaica Plain, MA UNITED STATES
Evangelos Pappas, PT, PhD, OCS, Lidcombe, NSW AUSTRALIA
Anastasios D. Georgoulis, MD, Prof., Ioannina GREECE

Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, GREECE, Ioannina, Epirus, GREECE

FDA Status Not Applicable

Summary: Braces can decrease the excessive tibial rotation that occurs during pivoting under high demand tasks in ACL-reconstructed knees with either BPTB or hamstring autografts. However, full restoration of normal tibial rotation is not achieved. This partial restoration of normal kinematics may have a potential benefit in patients recovering from ACL reconstruction especially during athletic activities.

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Abstract:

Background

It has been identified that the excessive tibial rotation that is presented in anterior cruciate ligament (ACL) deficient patients is not restored after ACL reconstruction during high demanding tasks, which are common in athletic activities regardless the reconstruction is performed with a bone-patellar tendon-bone (BPTB) or a hamstring graft. This pathological tibial rotation is considered to be related to chondral degeneration and early osteoarthritis in the knee joint. Bracing ACL-reconstructed knees might have the potential to limit this excessive tibial rotation that is reported during athletic tasks. The purpose of this study was to investigate if knee braces could restore normal rotational knee kinematics in ACL-reconstructed knees with either a BPTB or a hamstring autograft during high demanding tasks.

Methods

Twenty male subjects who had undergone unilateral ACL reconstruction with a BPTB autograft and twenty males, ACL reconstructed with a semitendinosus/gracilis (ST/G) autograft were assessed in vivo. An 8-camera optoelectronic system was used to collect kinematic data while each patient performed two stressful tasks; (1) immediate pivoting after descending from a stair, and (2) immediate pivoting after landing from a platform. Each task was performed under three experimental conditions for the reconstructed knee: (A) wearing a prophylactic brace (braced condition), (B) wearing a patellofemoral brace (sleeved condition) (C) without brace (unbraced condition). As a control group, patients with intact ACL were tested without any bracing.

Results

Concerning the ACL reconstruction with a BPTB graft, for both tasks, the range of motion (ROM) of tibial rotation was significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (p=0.014). Placing a brace or a sleeve on the ACL-reconstructed knee resulted in lower rotation than the unbraced condition (p=0.022) while no significant differences were found between the sleeved and the braced conditions (p=0.110). Regarding the ACL reconstruction with a ST/G graft, for both tasks, the ROM of tibial rotation was again significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (p=0.001). The use of brace or sleeve in the ACL-reconstructed knee resulted again in lower rotation than the unbraced condition (p=0.003). However, the braced condition resulted in lower rotation than the sleeved condition for the descending and pivoting task (p=0.031) while no differences were found for the landing and pivoting task (p=0.230).

Conclusions

Knee bracing limited the excessive tibial rotation that occurs during pivoting under high loading activities in ACL-reconstructed knees regardless the reconstruction was performed with a BPTB or a ST/G autograft. However, full restoration to normative values was not achieved in any of these cases. This partial restoration of normal kinematics may have a potential benefit in patients recovering from ACL reconstruction. However future research should examine the clinical outcome of this study in ACL reconstructed patients.