Skip to main content
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 8/2019

26.07.2019 | Original Article • KNEE - ARTHROSCOPY

Avoid post operative bracing to reduce ACL rerupture rates

verfasst von: Arjun Ajith Naik, Bishwaranjan Das, Yogeesh D. Kamat

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 8/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

It has been quoted that the graft is more prone to injury in the early stages of ligamentization between 3 and 6 months when the muscles are weak and compliance with post-op protocol is waning. Purpose of this study was to evaluate the functional outcome of avoiding postoperative bracing following ACL reconstruction and early enhanced recovery protocol on the reinjuries of graft.

Methods

Thirty-two consecutive patients who underwent arthroscopic ACL reconstruction by a single surgeon in the same specialist center between October 2015 and May 2017 were included in the study. All the patients were educated regarding rehabilitation before the index surgery and preoperative quadriceps exercises had been initiated. Rehabilitation was undertaken as per a standard protocol with emphasis on early mobilization. No brace was used. Patients were followed up between 3 months and 1 year. Lysholm knee scores were evaluated at 6 and 12 months postoperatively.

Results

No failures were noted (failure defined as instability, stiffness or persistent pain). The average Lysholm knee score at 6 months was 88 and at 12 months period was 91. No statistical significance (P > 0.00001) was noted in the scores between braced and unbraced at 1 year.

Conclusion

ACL rehabilitation without a knee brace can indirectly prevent rerupture and is a cheaper as well as a safer method with better outcomes.
Literatur
1.
Zurück zum Zitat Okazaki K, Tashiro Y, Uemura M et al (2014) Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models. Open Access J Sports Med 5:65–72PubMedPubMedCentral Okazaki K, Tashiro Y, Uemura M et al (2014) Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models. Open Access J Sports Med 5:65–72PubMedPubMedCentral
2.
Zurück zum Zitat Feller JA, Webster KE (2016) Exploring the high reinjury rate in younger patients undergoing ACLR. Am J Sports Med 44(11):2827–2832CrossRef Feller JA, Webster KE (2016) Exploring the high reinjury rate in younger patients undergoing ACLR. Am J Sports Med 44(11):2827–2832CrossRef
3.
Zurück zum Zitat Rodríguez-Merchán EC (2016) Knee bracing after anterior cruciate ligament reconstruction. Orthopedics 39(4):602–609CrossRef Rodríguez-Merchán EC (2016) Knee bracing after anterior cruciate ligament reconstruction. Orthopedics 39(4):602–609CrossRef
4.
Zurück zum Zitat Bergstrand G, Cerulli G, Lorenzini M, Mikkelsen C, Werner S (2003) Can a postoperative brace in slight hyperextension prevent extension deficit after anterior cruciate ligament reconstruction? a prospective randomised study. Knee Surg Sports Traumatol Arthrosc 11:318–321CrossRef Bergstrand G, Cerulli G, Lorenzini M, Mikkelsen C, Werner S (2003) Can a postoperative brace in slight hyperextension prevent extension deficit after anterior cruciate ligament reconstruction? a prospective randomised study. Knee Surg Sports Traumatol Arthrosc 11:318–321CrossRef
5.
Zurück zum Zitat Argento G, Conteduca F, De Carli A, Di Sanzo V, Iorio R, Vadala A (2007) The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study. Knee Surg Sports Traumatol Arthrosc 15:365–371CrossRef Argento G, Conteduca F, De Carli A, Di Sanzo V, Iorio R, Vadala A (2007) The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study. Knee Surg Sports Traumatol Arthrosc 15:365–371CrossRef
6.
Zurück zum Zitat Andersson D, Karlsson J, Samuelsson K (2009) Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthrosc J Arthrosc Relat Surg 25:653–685CrossRef Andersson D, Karlsson J, Samuelsson K (2009) Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthrosc J Arthrosc Relat Surg 25:653–685CrossRef
7.
Zurück zum Zitat Davies L, Smith TO (2008) A systematic review of bracing following reconstruction of the anterior cruciate ligament. Physiotherapy 94:1–10CrossRef Davies L, Smith TO (2008) A systematic review of bracing following reconstruction of the anterior cruciate ligament. Physiotherapy 94:1–10CrossRef
8.
Zurück zum Zitat Brandsson S, Eriksson BI, Faxén E, Kartus J, Karlsson J (2001) 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 11:110–114CrossRef Brandsson S, Eriksson BI, Faxén E, Kartus J, Karlsson J (2001) 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 11:110–114CrossRef
9.
Zurück zum Zitat Cooper R, Feller JA, Webster KE (2002) Current Australian trends in rehabilitation following anterior cruciate ligament reconstruction. Knee 9:121–126CrossRef Cooper R, Feller JA, Webster KE (2002) Current Australian trends in rehabilitation following anterior cruciate ligament reconstruction. Knee 9:121–126CrossRef
10.
Zurück zum Zitat Eriksson BI, Karlsson J, Kartus J, Kohler K, Sernert N, Stener S (1997) Is bracing after anterior cruciate ligament reconstruction necessary? a 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace. Knee Surg Sports Traumatol Arthrosc 5:157–161CrossRef Eriksson BI, Karlsson J, Kartus J, Kohler K, Sernert N, Stener S (1997) Is bracing after anterior cruciate ligament reconstruction necessary? a 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace. Knee Surg Sports Traumatol Arthrosc 5:157–161CrossRef
11.
Zurück zum Zitat Ascatigno L, Astuto L, Barletta F, Maccagnano G, Notarnicola A (2016) Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study. Muscles Ligaments Tendons J 6(4):486–491PubMed Ascatigno L, Astuto L, Barletta F, Maccagnano G, Notarnicola A (2016) Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study. Muscles Ligaments Tendons J 6(4):486–491PubMed
12.
Zurück zum Zitat Ekeland A, Eriksson J, Risberg MA, Holm I, Steen H (1999) The effect of knee bracing after anterior cruciate ligament reconstruction: a prospective, randomized study with two years follow-up. Am J Sports Med 27(1):76–83CrossRef Ekeland A, Eriksson J, Risberg MA, Holm I, Steen H (1999) The effect of knee bracing after anterior cruciate ligament reconstruction: a prospective, randomized study with two years follow-up. Am J Sports Med 27(1):76–83CrossRef
13.
Zurück zum Zitat Birmingham TB, Kirkley A, Kramer JF et al (2001) Knee bracing after ACL reconstruction: effects on postural control and proprioception. Med Sci Sports Exerc 33:1253–1258CrossRef Birmingham TB, Kirkley A, Kramer JF et al (2001) Knee bracing after ACL reconstruction: effects on postural control and proprioception. Med Sci Sports Exerc 33:1253–1258CrossRef
14.
Zurück zum Zitat Jansson A, Renström P, Swirtun LR (2005) The effects of a functional knee brace during early treatment of patients with a nonoperated acute anterior cruciate ligament tear: a prospective randomized study. Clin J Sport Med 15:299–304CrossRef Jansson A, Renström P, Swirtun LR (2005) The effects of a functional knee brace during early treatment of patients with a nonoperated acute anterior cruciate ligament tear: a prospective randomized study. Clin J Sport Med 15:299–304CrossRef
15.
Zurück zum Zitat Ménétrey J, Duthon VB, Laumonier T, Fritschy D (2008) “Biological failure” of the anterior cruciate ligament graft. Knee Surg Sports Traumatol Arthrosc 16(3):224–231CrossRef Ménétrey J, Duthon VB, Laumonier T, Fritschy D (2008) “Biological failure” of the anterior cruciate ligament graft. Knee Surg Sports Traumatol Arthrosc 16(3):224–231CrossRef
16.
Zurück zum Zitat Birmingham TB, Bryant DM, Donner A, Fowler PJ, Giffin JR, Litchfield RB, Kramer JF (2008) A randomized controlled trial comparing the effectiveness of functional brace and neoprene sleeve uses after anterior cruciate ligament reconstruction. Am J Sports Med 36(4):648–655CrossRef Birmingham TB, Bryant DM, Donner A, Fowler PJ, Giffin JR, Litchfield RB, Kramer JF (2008) A randomized controlled trial comparing the effectiveness of functional brace and neoprene sleeve uses after anterior cruciate ligament reconstruction. Am J Sports Med 36(4):648–655CrossRef
17.
Zurück zum Zitat Scheffler SU, Unterhauser FN, Weiler A (2008) Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16(9):834–842CrossRef Scheffler SU, Unterhauser FN, Weiler A (2008) Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16(9):834–842CrossRef
18.
Zurück zum Zitat Bailey L, Davis EP, Lowe WR, Warth RJ (2017) Functional bracing after anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 25(3):239–249CrossRef Bailey L, Davis EP, Lowe WR, Warth RJ (2017) Functional bracing after anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 25(3):239–249CrossRef
19.
Zurück zum Zitat Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39:100–110CrossRef Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39:100–110CrossRef
20.
Zurück zum Zitat Kaplan Y, Kvist J, Myklebust G, Thomeé R, Risberg MA, Theisen D et al (2011) Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1798–1805CrossRef Kaplan Y, Kvist J, Myklebust G, Thomeé R, Risberg MA, Theisen D et al (2011) Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1798–1805CrossRef
21.
Zurück zum Zitat Michael SG, Warren R et al (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34(12):2026–2037CrossRef Michael SG, Warren R et al (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34(12):2026–2037CrossRef
22.
Zurück zum Zitat McDevitt ER, Miller MD, Taylor DC et al (2004) Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study. Am J Sports Med 32(8):1887–1892CrossRef McDevitt ER, Miller MD, Taylor DC et al (2004) Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study. Am J Sports Med 32(8):1887–1892CrossRef
23.
Zurück zum Zitat Musgrove T, Pinczewski L, Refshauge K, Russell V, Salmon L (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21(8):948–957CrossRef Musgrove T, Pinczewski L, Refshauge K, Russell V, Salmon L (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21(8):948–957CrossRef
24.
Zurück zum Zitat Andrish JT, Kurosaka M, Yoshiya S (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229CrossRef Andrish JT, Kurosaka M, Yoshiya S (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229CrossRef
25.
Zurück zum Zitat Brandon C, Palmieri-Smith RM, Thomas AC, Wojtys EM (2016) Muscle atrophy contributes to quadriceps weakness after ACL reconstruction. J Sci Med Sport 19(1):7–11CrossRef Brandon C, Palmieri-Smith RM, Thomas AC, Wojtys EM (2016) Muscle atrophy contributes to quadriceps weakness after ACL reconstruction. J Sci Med Sport 19(1):7–11CrossRef
26.
Zurück zum Zitat McDevitt ER, Taylor DC, Miller MD et al (2004) Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study. Am J Sports Med 32(8):1887–1892CrossRef McDevitt ER, Taylor DC, Miller MD et al (2004) Functional bracing after anterior cruciate ligament reconstruction: a prospective, randomized, multicenter study. Am J Sports Med 32(8):1887–1892CrossRef
27.
Zurück zum Zitat Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21(8):948–957CrossRef Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21(8):948–957CrossRef
28.
Zurück zum Zitat Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229CrossRef Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229CrossRef
29.
Zurück zum Zitat Thomas AC, Wojtys EM, Brandon C, Palmieri-Smith RM (2016) Muscle atrophy contributes to quadriceps weakness after ACL reconstruction. J Sci Med Sport 19(1):7–11CrossRef Thomas AC, Wojtys EM, Brandon C, Palmieri-Smith RM (2016) Muscle atrophy contributes to quadriceps weakness after ACL reconstruction. J Sci Med Sport 19(1):7–11CrossRef
Metadaten
Titel
Avoid post operative bracing to reduce ACL rerupture rates
verfasst von
Arjun Ajith Naik
Bishwaranjan Das
Yogeesh D. Kamat
Publikationsdatum
26.07.2019
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 8/2019
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-019-02521-4

Weitere Artikel der Ausgabe 8/2019

European Journal of Orthopaedic Surgery & Traumatology 8/2019 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.