Functional Knee Brace Research Articles

Functional knee brace use for 21 h leads to a longer duration to achieve peak vertical ground reaction forces and the removal of the brace after 17.5 h results in faster loading of the knee joint.

To investigate the landing strategies used after discontinuing and continuing the use of a functional knee brace (FKB) while performing a drop jump. Following published methodology and power analysis, 23 uninjured male athletes, mean age of 19.4 ± 3.0 years, performed seven tests, during three test conditions (nonbraced, bracedand removed brace or continued brace use), over 6 days of 12 testing sessions (S) for a total of 38.5 h. Each subject was provided with a custom-fitted FKB. This study focuses on the single leg drop jump kinetics during S12 when subjects were randomly selected to remove the FKB after 17.5 h or continued use of FKB. The time to peak vertical ground reaction forces (PVGRF) and PVGRF were recorded on landing in eight trials. After brace removal, a significantly shorter mean time to PVGRF was recorded (9.4 ± 22.9 msec (3.9%), p = 0.005, 95% confidence interval (95% CI): -168.1, 36.1), while continued brace use required a nonsignificant (n.s.) longer mean duration to achieve PVGRF (19.4 ± 53.6 msec (8.9%), n.s., 95% CI: -49.7, 73.4). No significant mean PVGRF difference was found in brace removal (25.3 ± 65.8 N) and continued brace use (25.1 ± 23.0 N). Removal of FKB after 17.5 h of use led to a significantly shorter time to achieve PVGRF, while continued brace use for 21 h required a longer duration to achieve PVGRF, suggesting faster and slower knee joint loading, respectively. Understanding the concerns associated with the use of FKB and the kinetics of the knee joint will assist clinicians in counselling athletes about the risks and benefits of using an FKB. Level II.

The effect of a knee brace in dynamic motion-An instrumented gait analysis.

BackgroundOsteoarthritis (OA) is a common problem in the older population. To reduce pain and stress in the affected knee joint compartment, a functional knee brace is often prescribed by physicians to protect it from high loads.ObjectivesAn instrumented gait analysis should evaluate how the 4-point knee orthosis for varus or valgus load relief (M.4s OA) changes the kinematics of the knee, especially in the frontal plane.Methods17 healthy participants took part and were analyzed with an inertial sensor system (MyoMotion) giving continuous, objective information on the anatomical angles. The measurements were made both without wearing a knee brace and with the brace in different settings.ResultsThe results show a significant reduction in the maximum knee abduction and raised knee adduction. The knee brace, with a strong adjustment in varus or valgus orientation, caused a shift of maximum ab-/adduction in the proposed direction in 69% and 75% of the dynamic tests, respectively. The knee motion in the frontal plane shows individual movement patterns.ConclusionThe use of the brace leads to significant changes in the knee’s movement. Patient-specific movement patterns may explain different effects of functional knee braces on individual persons. Inertial sensors have been shown to be a low-cost, easy-to-use option for individual movement analysis and further personalized therapy.

Physical Performance Improves With Time and a Functional Knee Brace in Athletes After ACL Reconstruction.

Background:Athletes who return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) often have reduced physical performance and a high reinjury rate. Additionally, it is currently unclear how physical performance measures can change during the RTS transition and with the use of a functional knee brace.Purpose/Hypothesis:The purpose of this study was to examine the effects of time since surgery (at RTS and 3 months after RTS) and of wearing a brace on physical performance in patients who have undergone ACLR. We hypothesized that physical performance measures would improve with time and would not be affected by brace condition.Study Design:Controlled laboratory study.Methods:A total of 28 patients who underwent ACLR (9 males, 19 females) completed physical performance testing both after being released for RTS and 3 months later. Physical performance tests included the modified agility t test (MAT) and vertical jump height, which were completed with and without a knee brace. A repeated-measures analysis of variance determined the effect of time and bracing on performance measures.Results:The impact of the knee brace was different at the 2 time points for the MAT side shuffle (P = .047). Wearing a functional knee brace did not affect any other physical performance measure. MAT times improved for total time (P < .001) and backpedal (P < .001), and vertical jump height increased (P = .002) in the 3 months after RTS.Conclusion:The present study showed that physical performance measures of agility and vertical jump height improved in the first 3 months after RTS. This study also showed that wearing a knee brace did not hinder physical performance.Clinical Relevance:Wearing a functional knee brace does not affect physical performance, and therefore a brace could be worn during the RTS transition without concern. Additionally, physical performance measures may still improve 3 months past traditional RTS, therefore justifying delayed RTS.

The Effect of Functional Knee Braces on Muscular Contributions to Joint Rotational Stiffness in Anterior Cruciate Ligament-Deficient and -Reconstructed Patients.

Functional knee braces are frequently prescribed by physicians to ameliorate the function of individuals with anterior cruciate ligament (ACL) injuries. These braces have been shown in the literature to potentially enhance knee stability by augmenting muscle activation patterns and the timing of muscle response to perturbations. However, very few techniques are available in the literature to quantify how those modifications in lower-limb muscle activity influence stability of the knee. The aim of the present study was to quantify the effect of an off-the-shelf functional knee brace on muscle contributions to knee joint rotational stiffness in ACL-deficient and ACL-reconstructed patients. Kinematic, electromyography, and kinetic data were incorporated into an electromyography-driven model of the lower extremity to calculate individual and total muscle contributions to knee joint rotational stiffness about the flexion-extension axis, for 4 independent variables: leg condition (contralateral uninjured, unbraced ACL injured, and braced ACL injured); knee flexion (5°-10°, 20°-25°, and 30°-35°); squat stability condition (stable and unstable); and injury status (ACL deficient and ACL reconstructed). Participants had significantly higher (P < .05, η2 = .018) total knee joint rotational stiffness values while wearing the brace compared with the control leg. A 2-way interaction effect between stability and knee flexion (P < .05, η2 = .040) for total joint rotational stiffness was also found.

Innovations in functional and rehabilitative knee bracing

New knee brace designs are available that have the potential to improve patient outcomes relative to traditional bracing. For the indications of post-knee injury/surgery recovery, conservative management of knee osteoarthritis (OA), total knee arthroplasty (TKA) pre-habilitation, and the treatment of post-surgical extension deficits/flexion contractures, innovative new bracing designs merit review and discussion. The researchers requested information from industry brace manufacturers, and from the information received, have selected those products considered significant improvements over traditional functional brace designs for review in this article. Clinical research supporting the benefits of the innovative products listed in the article have been cited when available. The authors are both Certified Orthotists with over 50 years of combined knee bracing experience.

Hop testing symmetry improves with time and while wearing a functional knee brace in anterior cruciate ligament reconstructed athletes

BackgroundThere is currently no consensus among orthopaedic surgeons as to when patients with anterior cruciate ligament reconstruction are ready to return to sport or whether or not patients should wear a functional knee brace during athletic activity. The purpose of the present study was to determine the effects of time since return to sport and of a functional knee brace on hop distance and loading symmetry during hop testing in patients with anterior cruciate ligament reconstruction. MethodsTwenty-eight patients with anterior cruciate ligament reconstruction completed hop testing after being released to return to sport and again 3 months later, both with and without wearing a custom fit extension constraint functional knee brace. The loadsol® captured plantar loading data (100 Hz) to quantify peak impact force, loading rate, and impulse during the final landing of every hop test. A limb symmetry index was calculated between surgical and non-surgical limbs for hop distance and loading measures. FindingsWearing a knee brace increased hop distance symmetry during the single and crossover hop tests and peak impact force symmetry on each test (all p < 0.05). While single (p = 0.022) and triple (p = 0.002) hop distance symmetry increased with time, there was no effect of time on any loading symmetry outcomes. InterpretationThese results support using a functional knee brace during athletic activities for improving symmetry in the early return to sport period. These results also support previous findings that while hop distance symmetry improves with time, asymmetrical landing mechanics do not and should be addressed clinically.

The Impact of a Functional Knee Brace on Sports Performance Following ACL Reconstruction.

The Impact of a Functional Knee Brace on Sports Performance Following ACL Reconstruction.

RANDOMIZED PROSPECTIVE STUDY ON THE TREATMENT OF FEMORO-PATELLAR OSTEOARTHRITIS USING BRACING.

ABSTRACTObjective:To compare the effect of a brace designed to stabilize the patellofemoral joint to that of a patella-shaped neoprene sleeve with patella cut out in patients with patellofemoral osteoarthritis.Methods:Fifty-seven patients with femoro-patellar osteoarthritis were allocated to two groups: patients with femoro-patellar functional brace and those with a neoprene knee with a patellar orifice. Both groups underwent clinical treatment of osteoarthritis and used medications daily 1 month before and up to 3 months after brace placement. They were evaluated with the WOMAC and Lequesne questionnaires and performed five times sit to stand test, Timed Up and Go test, and six minutes walk test immediately before and 1 and 3 months after brace placement.Results:Both groups had improved pain, stiffness, and function with no difference between groups. Drug use decreased in both groups in the first month but increased in the third month. Naproxen use was progressively higher in the control group.Conclusion:Both knee orthoses improved pain and function and altered drug use only in the first month. Functional knee brace provided analgesia without increased use of naproxen. Level of Evidence IB, Randomized clinical trial

Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain.

The effectiveness of ACL functional knee braces to reduce meniscal and ACL strain after ACL injury or reconstruction is not well understood. A new dynamic knee tensioning brace system has been designed to apply an active stabilizing force to the knee. The ability of this system to reduce tissue strains is unknown. The purpose of this study was to test the ability of the dynamically tensioned brace to reduce strain in both the ACL and meniscus during rehabilitation activities. A combined in vivo/in silico/in vitro method was used to study three activities: gait, double leg squat, and single leg squat. Muscle forces and kinematics for each activity were derived through in vivo motion capture and applied to seven cadaveric knee specimens fitted with custom braces. Medial meniscal strain and ACL strain were measured in ACL intact, deficient and reconstructed conditions. The brace lowered peak and average meniscal strain in ACL deficient knees (P < 0.05) by an average of 1.7%. The brace was also found to lower meniscal strain in reconstructed knees (1.1%) and lower ACL strain in ACL intact (1.3%) and reconstructed knees (1.4%) (P < 0.05). This study supports the use of a brace equipped with a dynamic tensioning system to lower meniscal strain in ACL-deficient knees. Its use may help decrease the risk of subsequent meniscal tears in chronic ACL deficiency or delayed reconstruction. In ACL-intact and reconstructed knees, the brace may be beneficial in injury prophylaxis or in protecting the ACL graft following reconstruction. These results will aid clinicians make informed recommendations for functional brace use in patients with unstable knees. II.

Do Knee Braces Prevent Ski Knee Injuries?

Background: Alpine skiing has high rates of knee injuries. Prophylactic knee braces (PKBs) and functional knee braces (FKBs) are often prescribed by clinicians to reduce injuries or re-injuries in skiers. Objectives: This literature review evaluates current knowledge on the biomechanical and clinical effectiveness of prophylactic and functional knee braces in preventing knee injuries and their impact on the athletic performance of non-injured and injured individuals. Methods: A literature review was performed to analyze the efficiency of knee braces concerning the reduction of mechanical stress, influence on muscle control, performance and injury prevention. Results: Most of the available literature describes research on the use of knee braces in contact sports, specifically American football. In this context, several studies show braces to be more effective in preventing medial collateral ligament injuries than anterior cruciate ligament injuries in both cadaveric and clinical studies. The use of functional braces after anterior cruciate ligament reconstruction has been supported and refuted in both postoperative and long-term studies. Ski-specific studies show a positive effect of knee braces on proprioception; no influence on performance; and a protective effect on previously injured skiers. Conclusions: Current literature indicates PKBs may have a protective function in healthy patients, while influence on performance is minimal. Functional braces are recommended in ACL-deficient patients and are biomechanically effective under low-loading conditions. They may not be as effective in high-loading conditions, such as athletic activity. There is a protective effect of FKBs of preventing re-rupture of reconstructed ACLs and preventing further knee injuries on ACL-deficient knees in skiers. More research is needed to determine the effectiveness of PKBs snow sports.

Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

The purpose of this study was to evaluate the current literature on the use of functional knee braces after anterior cruciate ligament (ACL) reconstruction with respect to clinical and in vivo biomechanical data. A systematic search of both the PubMed and Embase databases was performed to identify all studies that reported clinical and/or in vivo biomechanical results of functional bracing versus nonbracing after ACL reconstruction. Extracted data included study design, surgical reconstruction techniques, postoperative rehabilitation protocols, objective outcomes, and subjective outcomes scores. The in vivo biomechanical data collected included kinematics, strength, function, and proprioception. Subjective clinical outcomes scores were collected when available. Quality appraisal analyses were performed using the Cochrane Collaboration tools for randomized and nonrandomized trials to aid in data interpretation. Fifteen studies met the selection criteria (including 3 randomized trials [level II], 11 nonrandomized trials [level II], and 1 retrospective comparative study [level III]), with follow-up intervals ranging from 3 to 48 months. Most studies were designed to compare the effects of functional bracing versus nonbracing on subjective and objective results in patients who underwent previous primary ACL reconstruction. Functional bracing significantly improved kinematics of the knee joint and improved gait kinetics, although functional bracing may decrease quadriceps activation without affecting functional tests, range of motion, and proprioception. Four studies reported no differences in subjective outcomes scores with brace use; however, one study reported increased patient confidence with brace use, whereas another study reported decreased pain and quicker return to work when the brace was not used. The effectiveness of postoperative functional bracing following ACL reconstruction remains elusive. Some data suggest that functional bracing may have some benefit with regard to in vivo knee kinematics and may offer increased protection of the implanted graft after ACL reconstruction without sacrificing function, range of motion, or proprioception. However, limited evidence exists supporting the use of routine functional bracing to decrease the rate of reinjury after ACL reconstruction.

The Effects of Functional Knee Brace on Postural Control in Patients Who Underwent Anterior Cruciate Ligament Reconstruction

Background: The current study aimed to evaluate the postural control in patients underwent anterior cruciate ligament reconstruction pre and post wearing functional knee brace. Methods: Eighteen athletes undergone unilateral anterior cruciate ligament reconstruction included in the study. They had unilateral anterior cruciate ligament reconstruction at least six months before session test. Postural control was assessed pre and post wearing custom-fit functional knee brace using a posturographic platform prokin 254. The balance tests included: 1) standing on prokin platform with eyes open/closed on anterior cruciate ligament reconstruction limb, 2) standing on prokin platform with eyes open/closed on both limbs. The standard deviation (SD) of body sway along the anteroposterior (AP) and mediolateral (ML) axis, mean velocity of center of pressure (COP) along AP/ ML axis and the area ellipse (measured in 2 mm) were calculated. Results: Results of the paired T-test revealed a significant effect on selected postural control variables for the brace conditions especially in low challengeable conditions (double leg, eyes open test situations) (P < 0.05). But in high challengeable conditions this effect was not significant. Conclusions: Functional knee brace improved postural control in the simple balancing task in the subjects with anterior cruciate ligament reconstruction. But this improvement in more difficult balancing task was limited.

Knee Bracing After Anterior Cruciate Ligament Reconstruction.

Although some articles in the literature are in favor of the use of a postoperative brace after anterior cruciate ligament (ACL) reconstruction, this review found that several systematic reviews and other reports on the topic do not support the use of a postoperative brace after ACL reconstruction. There is no scientific evidence so far to support the routine use of a functional knee brace following a successful ACL reconstruction in the postoperative course. Most authors believe that bracing is not necessary. There is insufficient evidence to inform current practice. Good-quality randomized trials are required to remedy this situation. Future studies should better define the role of a brace following ACL surgery. A search of MEDLINE for articles published between January 1, 1995, and September 30, 2013, was performed. Key search terms used were ACL reconstruction and knee brace. Ninety-one articles were found, but only 28 focused on the subject of bracing after ACL reconstruction and were selected for this review. Several systematic reviews and randomized, controlled trials on the topic do not recommend the use of postoperative brace after ACL reconstruction. Postoperative bracing after ACL reconstruction does not seem to help with pain, function, rehabilitation, and stability. The literature does not support the use of a postoperative brace following ACL reconstruction. [Orthopedics. 2016; 39(4):e602-e609.].

Movement and Loading Symmetry Changes when Wearing a Functional Knee Brace Following ACL Reconstruction

Movement and Loading Symmetry Changes when Wearing a Functional Knee Brace Following ACL Reconstruction

Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge.

Background:Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information.Objectives:In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients.Patients and Methods:For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur.Results:Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant.Conclusion:Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise.

The Effectiveness of a Functional Knee Brace on Joint-Position Sense in Anterior Cruciate Ligament-Reconstructed Individuals.

It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients' return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions.

Electromyographic analysis of anterior cruciate deficient knees with and without functional bracing during lunge exercise.

The use of functional knee braces for returning to sports or during demanding activities following anterior cruciate ligament rupture is common; yet despite being commonly prescribed, its mechanism of action remains unknown. To examine the effect of functional knee braces on mean muscle activity when performing lunge exercises. Pre-/post-test (within-subject research design). A total of 10 male participants with unilateral isolated anterior cruciate ligament deficiency participated. Electromyographic activities of six muscles around the knee were recorded during lunge exercises, with and without wearing a custom functional knee brace. The lunge cycle movement was subdivided into three phases: eccentric, isometric, and concentric. The quadriceps and hamstrings were no different in the braced and unbraced conditions. When braced, the mean amplitude of the medial gastrocnemius was significantly lower throughout the whole movement (p = 0.01) and during the concentric (p = 0.006) and eccentric (p = 0.028) phases, but not within the isometric phase. The lateral gastrocnemius was found to have lower mean amplitude in the isometric phase (p = 0.044). With its origin on the medial femoral condyle, perhaps reduced medial gastrocnemius activity may better guide knee rotation and assist the joint achieving a healthier kinematic pattern. Lower medial gastrocnemius activity may facilitate lower medial compartment contact pressure, for which greater loading is known to increase the risk of osteoarthritis in anterior cruciate ligament-deficient (ACLD) knees. However, further research is needed.

Treatment of Type 3 Arthrofibrosis Following Arthroscopic Reconstruction of ACL and Posterolateral Corner Injury with Tibia Plateau Fracture in a Professional Dancer

Objectives:Arthrofibrosis is a serious complication following the reconstruction of anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury. Loss of motion caused by arthrofibrosis can be disabling in young and active patients. We report the clinical results of the treatment of arthrofibrosis following arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft and surgically repairing PLC with 2 suture anchors in a 30 year-old professional dancer, treated with surgical lysis and manipulation under general anesthesia followed by aggressive physical therapy.Methods:A 30 year-old male professional dancer presented with pain, effusion and severe instability in his left knee after falling in a dance event. The pain was evaluated on Visual analog scale (VAS) as 6 to 8. At the physical examination, anterior drawer test was evaluated as grade 3, pivot shift test, varus test, dial test and posterolateral drawer test were found positive. The Tegner Lysholm score was evaluated as 22 (poor). Under general anesthesia, left knee had tendency to external rotation and recurvatum when leg was suspended by toes. A magnetic resonance image (MRI) revealed the presence of a total ACL rupture, PLC injury and a fracture of lateral tibia plateau. The patient was treated with arthroscopic reconstruction of ACL with ipsilateral hamstring tendon graft fixed with endobutton through femoral tunnel and bio interference screw through tibial tunnel and PLC injury was treated with 2 suture anchors. Postoperatively first day, quadriceps musculature and active and passive ROM exercises was trained. During postoperatively third week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. At the sixth week, arthroscopic lysis was performed due to type 3 arthrofibrosis. At the tenth week, manipulation was performed to the left knee under general anesthesia.Results:At the 3 month- follow-up, the patient achieved full symmetric restoration of motion and he had returned to full daily activities. The Tegner Lysholm score was evaluated as 94 (excellent) postoperatively. Functional examination of the left knee reveled 155 of flexion, and full knee extension. The complaint of instability was disappeared. At 9 month-follow-up, clinical findings were unremarkable, with no sign of re-rupture and arthrofibrosis and he returned to his professional dance career.Conclusion:In the literature there is not any consensus regarding the management and rehabilitation intervention for arthrofibrosis in young athletes or professional dancers. The best treatment method is preventing the arthrofibrosis once it has occurred with surgical lysis and aggressive physical therapy. The combined surgical treatment and physiotherapy described in this case report may assist clinicians in the treatment of arthrofibrosis after arthroscopic reconstruction of ACL and PLC injury.

Arthroscopic Reconstruction of Chronic Isolated Posterior Cruciate Ligament Instability in a Professional Dancer

Objectives:Chronic isolated injuries of the posterior cruciate ligament (PCL) are very rare in the literature. PCL injuries are often presented undiagnosed because of the weak signs of the injury compared to the anterior cruciate ligament (ACL) injuries. We report the surgical outcome of arthroscopic reconstruction of the chronic isolated PCL rupture with ipsilateral autologous hamstring tendon in a professional Caucasian dancer.Methods:A 21-year-old male professional Caucasian dancer presented severe instability without any pain in his right knee lasting for one year. The patient did not describe any specific traumatic event but his both knees received repeatitive direct pretibial trauma during hyperflexion of the knee while landing to the floor. At the physical examination, posterior sagging of the tibia was observed on the affected side at 90o of knee flexion and step off test and posterior drawer test were positive preoperatively under general anesthesia. The Tegner Lysholm score was evaluated as 59 (poor). A magnetic resonance image (MRI) revealed the isolated total rupture of PCL. The treatment of choice was arthroscopic single bundle reconstruction of PCL with ipsilateral autologous hamstring tendon. A standard arthroscopic exploration of the joint was performed preoperatively and we didn't observe any meniscal, cartilage or ligamentous lesion. Anteromedial and anterolateral portals were made in order to visualize the posterior cortex of the tibia with a 70 degree scope. Intra-operative fluroscopy was used to confirm proper tunnel position. During postoperatively first week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. Quadriceps musculature and passive range of motion was trained.Results:At the 6 month- follow-up, the patient achieved full symmetric restoration of motion. He had returned to full daily activies. The Tegner Lysholm score was evaluated as 95 (excellent) postoperatively. Functional examination of the right knee reveled 140 of flexion, and full knee extension. No posterior sagging was observed and step off test and posterior drawer test was negative. The complaint of instability was disappeared. At 1-year follow-up, clinical findings were unremarkable, with no sign of re-rupture and he returned to his professional career.Conclusion:Surgical reconstruction technique of the PCL and associated rehabilitation protocols has not yet been fully standardized and much work still has be done optimizing correct treatment of PCL injuries. The arthroscopic reconstruction of chronic isolated PCL instability is a very difficult technique as well as its diagnosis. The reconstruction is very beneficial in the athletes and the patients who are not responding well to the conservative treatment.

Which one Enhances Muscular Performance in ACL Reconstructed Subjects

Objectives:The aim of this study was to investigate the effects of functional knee brace and kinesiotaping on muscular performance in anterior cruciate ligament reconstructed subjects who reached return to sport phase of the rehabilitation.Methods:Twenty (17 males, 3 females, Age: 24.7±7.1 years, Body weight: 74.4±12.0 kg, Height: 177.9±6.5 cm, BMI: 23.9±3.6 kg/m2) subjects who underwent anterior cruciate ligament reconstruction by using hamstring tendon auto graft were included in this study. When the subjects reached the return to sports phase of rehabilitation which was 6th months after surgery, knee muscle strength, jump performance and balance tests were performed 3 times: bare, with knee brace and with kinesio taping. The order of the tests were randomized to eliminate the effects of fatigue and motor learning. Quadriceps and hamstring muscle strength was measured on an isokinetic dynamometer at 180 °/s and 60°/s angular velocities. Vertical Jump (VJ) and One Leg Hop Tests (OLHT) were used to assess jump performance. Star Excursion Balance Test (SEBT) with anterior, posteromedial and posterolateral reach distance was used to assess the dynamic balance. When all tests were performed, the subjects were asked under which test condition they felt more confident. Repeated measures of ANOVA was used to analyze the difference among three test conditions (bare, kinesiotaping, knee brace). Bonferroni post hoc test was used for pairwise comparison.Results:SEBT posteromedial (PM)and posterolateral (PL) reach distances were found significantly different among three test conditions(PM: F(2,38)=3.42,p=0.04), PL: F(2,38)=4.37,p=0.02). Kinesiotaping increased posteromedial reach distance (p=0.03). On the other hand, brace decreased posterolateral reach distance (p=0.04). VJ and OLHT performance were also found significantly different between three test conditions (VJ: F (2,38)=3.44,p=0.04, OLHT: (F(2,38)=4.04,p=0.02). Kinesio taping increased one leg hop distance (p=0.01). However, brace decreased VJ distance (p=0.04). Kinesiotaping had no effect on quadriceps and hamstring strength (p>0.05). Only brace increased the quadriceps strength at 180 °/s (p=0.02). 40% of the subjects felt more confident with knee brace; 25% of them were more confident with kinesiotaping and the rest (35%) of them were more confident with no brace and kinesiotaping.Conclusion:Kinesiotaping enhances balance and jump performance except for increasing knee strength in ACLR subjects at 6th months after surgery when they normally return to their sport. Although, knee brace increases quadriceps strength, it has adverse effect on functional performance . Therefore, Kinesiotaping can be applied for those patients when they start their sport specific training to enhance functional performance.