TO BRACE OR NOT TO BRACE? EARLY POSTOPERATIVE OUTCOME AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING A HAMSTRING GRAFT: A RANDOMIZED PROSPECTIVE STUDY

M. Venosa¹ , E. Romanini² , G. Cazzato¹ , A. Vespasiani³ , G. Petralia⁴, G. Placella⁵ , G. Logroscino⁶ , S. Cerciello⁷

¹ RomaPro Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
² GLOBE, Italian Working Group on Evidence-Based Orthopaedics, Rome, Italy
³ Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy;
⁴ Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
⁵ Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
⁶ Department of Mini-Invasive and Computer-Assisting Orthopaedic Surgery, San Salvatore Hospital, L'Aquila, Italy
⁷ Unicamillus - Saint Camillus International University of Health Sciences, Rome, Italy

Correspondence to:

Journal of Orthopedics 2022 Sep-Dec; 14(3): 108-116
https://doi.org/10.69149/orthopedics/2022v14iss3_4

Received: 25 September 2022 Accepted: 15 November 2022

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Abstract

The aim of this study is to compare the clinical outcomes of a consecutive series of 186 patients having been treated for anterior cruciate ligament reconstruction with a hamstring graft in whom a brace was used or not in the early postoperative period. A randomized prospective study of athletes undergoing anterior cruciate ligament reconstruction using the same surgical technique and the same graft (hamstring) was carried out. Three different groups were investigated: no brace, rigid brace in full extension (for 4 weeks), or articulated brace (0-90° for first 3 weeks then 0-120° for another week). All patients were assessed preoperatively and at follow-up for thigh muscle atrophy, range of motion, pain, quality of life, and subjective scores (Lysholm-Tegner score, IKDC score). Rehabilitation started at 2.2 ± 1.3 days after surgery. All of the athletes followed the same postoperative rehabilitation protocol with progressive daily sessions that ended 24 weeks after surgery. No significant differences were found concerning the use of a brace in early postoperative rehabilitation. At the final follow-up (24 weeks after surgery), side-to-side differences in laxity (as measured by KT-1000 arthrometer) between the involved and not-involved leg were 2.2±1.6 mm for NB (no-brace) group, 2.1±1.2 mm for AB (articulated brace) group and 2.3±1.3 mm for RB (rigid brace) group. There were no significative post-operative side-to-side differences in knee circumference between the three groups at 24 weeks follow-up (0.3±0.2 cm in the NB group, 0.2±0.2 cm in the AB group, and 0.1±0.4 cm in the RB group, respectively). Post-operative IKDC scores were 86.2±6 in the NB group, 82±12.6 in the AB group, and 81.6±13.2 in the RB group respectively. There was no significative difference in terms of ROM between the three groups at 6, 12, and 24 weeks and similar functional improvement as measured by Lysholm-Tegner activity score at the final follow-up. The present study did not show any difference in the rate of complications or residual laxity and clinical outcomes among the three groups. According to these data, postoperative bracing after anterior cruciate ligament reconstruction did not show any advantage and cannot be recommended.

Keywords: anterior cruciate ligament, brace, hamstring graft, reconstruction, rehabilitation