Can a Knee Brace Prevent Acl Re-Injury: A Systematic Review

Abstract

Background:Recent literature shows a rate of ACL retear after ACLR when returning to sport between 8% and 23%, depending on the population and clinical implications. The risk of a second injury is higher in patients who (1) return to cutting and pivoting sports, (2) do not meet the return to sport criteria before returning to sport, and (3) returning to pivoting sports earlier than 9 months after ACLR. A second ACL injury, either a graft rupture or contralateral ACL injury after ACLR, negatively impacts knee function, quality of life, accelerates degenerative changes in the knee and challenges an athlete’s career.Purpose:This systematic review aimed to investigate whether a knee brace when returning to sport (RTS) could prevent a second injury after anterior cruciate ligament reconstruction (ACLR).Methods:This study was registered with the PROSPERO database and followed PRISMA guidelines. A systematic search of PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, EBSCO Sportdiscus and ISI Web of Science databases for meta-analysis, randomized controlled trials and prospective cohort studies published before July 2020 was undertaken. The inclusion criteria were: (1) Comparing with and without brace at RTS, (2) follow up of at least 18 months after ACLR, (3) reinjury rates included in the outcomes. Data were extracted independently by two reviewers. Quality appraisal analyses were performed for each study using the Cochrane Collaboration tools for randomized and nonrandomized trials.Results:A total of 1196 patients in 3 studies were included. One study showed a lower rate of reinjury when wearing a knee brace at RTS. One study found the knee brace to have a significant protective effect for younger patient. (p < 0.05).Conclusion:Current data cannot support that using a knee brace when RTS will decrease the rate of reinjury after ACL reconstruction.Table 1Inclusion and exclusion criteriaFigure 1.PRISMA Flow ChartTable 2Results of Systematic Quality Appraisal for Each Randomized Study Using the Cochrane Collaboration Tool for Assessing Risk of Bias in Randomized TrialsTable 3Results of Systematic Quality Appraisal for Each Nonrandomized Study Using the Cochrane Risk of Bias Assessment Tool for Nonrandomized Studies of InterventionTable 4Detailed results of included studies.Table 5Summary of Individual Study Characteristics