Comparison of Functional Outcomes With and Without Knee Bracing After Arthroscopic Anterior Cruciate Ligament Reconstruction Using a Quadriceps Tendon Autograft
DOI:
https://doi.org/10.31282/joti.v7n3.138Keywords:
Anterior Cruciate Ligament, ACL, Knee Bracing, ArthroscopyAbstract
Introduction: Knee bracing after anterior cruciate ligament (ACL) reconstruction aims to maintain range of motion (ROM), provide knee stability, and protect the reconstructed ligament. However, evidence regarding the routine use of knee braces after ACL reconstruction remains limited, and no study has evaluated this practice in Indonesia. This study aimed to compare functional outcomes between patients who used a knee brace and those who did not after arthroscopic ACL reconstruction using a quadriceps tendon autograft.
Methods: This randomized controlled trial included patients undergoing arthroscopic ACL reconstruction at a tertiary hospital in Jakarta between February 2022 and February 2023. Patients were randomized to postoperative knee bracing or no bracing. Clinical outcomes were assessed preoperatively and at 1, 3, and 6 months postoperatively using the International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), ACL Return to Sport after Injury (ACL-RSI) score, and Rollimeter measurement.
Results: There were no significant differences between groups in sex, injured knee side, or concomitant meniscal injury. No significant between-group differences were observed in IKDC, Lysholm, or KOOS scores at any assessment point (p>0.05). Rollimeter measurements showed significantly greater anterior translation in the bracing group at 1 and 3 months postoperatively (p=0.001 and p=0.003, respectively). A significant between-group difference in ACL-RSI scores was observed at 3 months postoperatively (p=0.004).
Conclusion: Knee bracing after arthroscopic ACL reconstruction using a quadriceps tendon autograft did not improve functional outcomes compared with no bracing. Routine postoperative bracing may therefore not provide additional functional benefit.
Downloads
References
1. Lowe WR, Warth RJ, Davis EP, Bailey L. Functional bracing after anterior cruciate ligament reconstruction: a systematic review. J Am Acad Orthop Surg. 2017;25(3):239-249.
2. Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries. Clin Sports Med. 2017;36(1):1-8.
3. Lubis AM, Dasril DF. Comparison of functional outcome between bone quadriceps tendon (BQT) and single-bundle hamstring tendon (SBHT) autograft in arthroscopic-assisted anterior cruciate ligament reconstruction cases: a prospective cohort study. Ann Med Surg (Lond). 2020;60:509-514.
4. Rudy, Mustamsir E, Phatama KY. Tensile strength comparison between peroneus longus and hamstring tendons: a biomechanical study. Int J Surg Open. 2017;9:41-44.
5. Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E. Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med. 2019;47(14):3531-3540.
6. Hurley ET, Mojica ES, Kanakamedala AC, Meislin RJ, Strauss EJ, Campbell KA, et al. Quadriceps tendon has a lower re-rupture rate than hamstring tendon autograft for anterior cruciate ligament reconstruction: a meta-analysis. J ISAKOS. 2022;7(2):87-93.
7. Scott WN, editor. Insall & Scott surgery of the knee. 6th ed. Philadelphia: Elsevier; 2018.
8. Sayampanathan AA, Howe BKT, Bin Abd Razak HR, Chi CH, Tan AHC. Epidemiology of surgically managed anterior cruciate ligament ruptures in a sports surgery practice. J Orthop Surg (Hong Kong). 2017;25(1):230949901668428.
9. Hagino T, Ochiai S, Senga S, Yamashita T, Wako M, Ando T, et al. Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg. 2015;135(12):1701-1706.
10. Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL. Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears. Am J Sports Med. 2012;40(9):2128-2133.
11. Pollet V, Barrat D, Meirhaeghe E, Vaes P, Handelberg F. The role of the Rolimeter in quantifying knee instability compared to the functional outcome of ACL-reconstructed versus conservatively-treated knees. Knee Surg Sports Traumatol Arthrosc. 2005;13(1):12-18.
12. Cummings JF, Grood ES. The progression of anterior translation after anterior cruciate ligament reconstruction in a caprine model. J Orthop Res. 2002;20(5):1003-1008.
13. Jacobi M, Reischl N, Rönn K, Magnusson RA, Gautier E, Jakob RP. Healing of the acutely injured anterior cruciate ligament: functional treatment with the ACL-Jack, a dynamic posterior drawer brace. Adv Orthop. 2016;2016:9076525.
14. Strutzenberger G, Braig M, Sell S, Boes K, Schwameder H. Effect of brace design on patients with ACL ruptures. Int J Sports Med. 2012;33(11):934-939.
15. Hefti E, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1(3-4):226-234.
16. Singh K, Singh V. Outcome assessment after anterior cruciate ligament reconstruction among non-athletes. Int J Contemp Med Res. 2020;7(10).
17. Gadea F, Monnot D, Quélard B, Mortati R, Thaunat M, Fayard JM, et al. Knee pain after anterior cruciate ligament reconstruction: evaluation of a rehabilitation protocol. Eur J Orthop Surg Traumatol. 2014;24(5):789-795.
18. Di Miceli R, Marambio C, Zati A, Monesi R, Benedetti M. Do knee bracing and delayed weight bearing affect mid-term functional outcome after anterior cruciate ligament reconstruction? Joints. 2017;5(4):202-206.
19. Lun DX, Hu YC, Yang XG, Wang Z, Yu XC, Wu SJ, et al. Development and proposal of a scoring system for giant cell tumour of the bone around the knee. Int Orthop. 2018;42(1):203-213.
20. 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.
21. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64.
22. Desai N, Björnsson H, Samuelsson K, Karlsson J, Forssblad M. Outcomes after ACL reconstruction with focus on older patients: results from the Swedish National Anterior Cruciate Ligament Register. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):379-386.
23. Wright RW, Huston LJ, Nwosu SK, Allen CR, Anderson AF, Cooper DE, et al. Rehabilitation predictors of clinical outcome following revision ACL reconstruction in the MARS cohort. J Bone Joint Surg Am. 2019;101(9):779-786.
24. Hopper GP, Aithie JMS, Jenkins JM, Wilson WT, Mackay GM. Combined anterior cruciate ligament repair and anterolateral ligament internal brace augmentation: minimum 2-year patient-reported outcome measures. Orthop J Sports Med. 2020;8(12):2325967120968913.
25. Sadeqi M, Klouche S, Bohu Y, Herman S, Lefevre N, Gerometta A. Progression of the psychological ACL-RSI score and return to sport after anterior cruciate ligament reconstruction: a prospective 2-year follow-up study from the French prospective anterior cruciate ligament reconstruction cohort study (FAST). Orthop J Sports Med. 2018;6(12):232596711881281.
26. McDevitt ER, Taylor DC, Miller MD, Gerber JP, Ziemke G, Hinkin D, et al. Functional bracing after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32(8):1887-1892.
27. Yapıcı F, Gür V, Sarı İF, Köksal A, Yurten H, Üçpunar H, et al. Prescription of knee braces after anterior cruciate ligament reconstruction: fact or fiction? Turk J Phys Med Rehabil. 2022;68(3):355-363.
28. Kinikli G, Callaghan M, Parkes M, Yuksel I. Bracing after anterior cruciate ligament reconstruction: systematic review and meta-analysis. Turkiye Klin J Sports Sci. 2014;6:28-38.
29. Masini BD, Owens BD. Current recommendations for anterior cruciate ligament bracing: when to use. Phys Sportsmed. 2013;41(1):35-39.
30. Balendra G, Jones M, Borque KA, Willinger L, Pinheiro VH, Williams A. Factors affecting return to play and graft re-rupture after primary ACL reconstruction in professional footballers. Knee Surg Sports Traumatol Arthrosc. 2022;30(7):2200-2208.
31. Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy. 2005;21(8):948-957.
32. Cohen D, Slawaska-Eng D, Almasri M, Sheean A, de Sa D. Quadricep ACL reconstruction techniques and outcomes: an updated scoping review of the quadricep tendon. Curr Rev Musculoskelet Med. 2021;14(6):462-474.
