Comparison of outcome following knee immobilization versus no immobilization in the immediate post operative period following arthroscopic anterior cruciate ligament reconstruction
DOI:
https://doi.org/10.18203/2349-2902.isj20222598Keywords:
Anterior cruciate ligament, Knee brace, Arthroscopy, RehabilitationAbstract
Background: Post operative bracing following ACL reconstruction has been traditionally used in post operative period to reduce pain limit knee range of motion to protect against valgus and varus stress. There is a lack of consensus in published literature regarding knee immobilization. The aim of this study is to compare the functional outcome and pain control in patients using knee immobilizer with those not using them in immediate post operative period.
Methods: A total of 60 patients admitted with ACL tear who were admitted from January 2020 to August 2021 were enrolled in this study and randomised into two groups, given knee immobilizer or no immobilizer following arthroscopic ACL reconstruction. Patients were assessed for pain, knee range of motion and functional outcome with 6-month follow-up.
Results: VAS score for pain was significantly lower for knee brace users (p=0.24) on post-op day2 but there was no significant difference on subsequent measurements. Also, the IKDC Score, arc of motion of knee joint and complication rate did not show significant difference between the two groups.
Conclusions: Based on this study, the use of a knee brace for improving short term outcome
following ACL reconstruction is not justified and adds to the cost of treatment. A short cylindrical back slab for 2-3days can serve the same purpose of controlling pain and soft tissue protection.
References
Zhang L, Liu G, Han B. Knee Joint Biomechanics in Physiological Conditions and How Pathologies Can Affect It: A Systematic Review. Appl Bionics Biomech. 2020;2020:7451683.
Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair past, present and future. J Exp Orthop. 2018;5(1):20.
Brandsson S, Faxén E, Kartus J, Eriksson BI, Karlsson J. Is a knee brace advantageous after anterior cruciate ligament surgery? A prospective, randomised study with a two-year follow-up. Scand J Med Sci Sports. 2001;11(2):110-4.
Sommerfeldt M, Bouliane M, Otto D, Rowe BH, Beaupre L. The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons. Can J Surg. 2015;58(1):48-53
Hiemstra LA, Veale K, Sasyniuk T. Knee immobilization in the immediate post-operative
period following ACL reconstruction: a survey of practice patterns of Canadian orthopedic surgeons. Clin J Sport Med. 2006;16(3):199-202.
Focke A, Steingrebe H, Möhler F. Effect of different knee braces in ACL-deficient patients. Front Bioeng Biotechnol. 2020;8:964.
Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. J Arthros. 2005;21(7):791-803.
Naik AA, Das B, Kamat YD. Avoid post operative bracing to reduce ACL rerupture rates. Eur J Orthop Surg Traumatol. 2019;29(8):1743-7.
Wright RW, Fetzer GB. Bracing after ACL reconstruction: a systematic review. Clin Orthop Relat Res. 2007;455:162-8.
Melegati G, Tornese D, Bandi M, Volpi P, Schonhuber H, Denti M. The role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction: a prospective controlled study. Knee Surg Sports Traumatol Arthrosc. 2003;11(5):322-6.
Mikkelsen C, Cerulli G, Lorenzini M, Bergstrand G, Werner S. Can a post-operative brace in slight hyperextension prevent extension deficit after anterior cruciate ligament reconstruction? A prospective randomised study. Knee Surg Sports Traumatol Arthrosc. 2003;11(5):318-21
Giotis D, Zampeli F, Pappas E, Mitsionis G, Papadopoulos P, Georgoulis AD. Effects of knee bracing on tibial rotation during high loading activities in anterior cruciate ligament-reconstructed knees. Arthroscopy. 2013;29(10):1644-52
LaPrade RF, Venderley MB, Dahl KD, Dornan GJ, Turnbull TL. Functional Brace in ACL Surgery: Force Quantification in an In Vivo Study. Orthop J Sports Med. 2017;5(7):2325967117714242
Yang XG, Feng JT, He X, Wang F, Hu YC. The effect of knee bracing on the knee function and stability following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res. 2019;105(6):1107-1114.
Hiemstra LA, Heard M, Buchko G, Sasyniuk TM, Reed J, Monteleone B. The Effect of Knee Immobilization on post-operative pain following anterior cruciate ligament (ACL) reconstruction A randomized clinical trial. Can J Surg. 2015;58(1):48-53.