Prophylactic Bracing Research Articles

Management and prevention of acute and chronic lateral ankle instability in athletic patient populations.

Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.

Differences in proprioception, muscle force control and comfort between conventional and new-generation knee and ankle orthoses

The aim of this study was to compare muscle force control and proprioception between conventional and new-generation experimental orthoses. Sixteen healthy subjects participated in a single-blind controlled trial in which two different types of orthosis were applied to the dominant knee or ankle, while the following variables were evaluated: muscle force control (accuracy), joint position sense, kinesthesia, static balance as well as subjective outcomes. The use of experimental orthoses resulted in better force accuracy during isometric knee extensions compared to conventional orthoses (P=0.005). Moreover, the use of experimental orthoses resulted in better force accuracy during concentric (P=0.010) and eccentric (P=0.014) ankle plantar flexions and better knee joint kinesthesia in the flexed position (P=0.004) compared to conventional orthoses. Subjective comfort (P<0.001) and preference scores were higher with experimental orthoses compared to conventional ones. In conclusion, orthosis type affected static and dynamic muscle force control, kinesthesia, and perceived comfort in healthy subjects. New-generation experimental knee and ankle orthoses may thus be recommended for prophylactic joint bracing during physical activity and to improve the compliance for orthosis use, particularly in patients who require long-term bracing.

Does prophylactic ankle bracing improve proprioception in the elderly?

Background: Falls are a common occurrence among the elderly, which result in many health care practitioners prescribing prophylactic ankle bracing (an assistive device) to improve proprioception and reduce the chance of falling. The aim of this study was to compare proprioception in a cohort of elderly individuals when prophylactically braced or unbraced on the Biodex System 3. Methods: Data were collected from 173 elderly individuals who resided at seven of the old age retirement institutions in the Highway area of Durban, South Africa. Information was obtained with voluntary informed consent. The participants completed a Fall Risk Questionnaire that categorized them into two groups: increased risk or poor risk for falling. Subsequently, they completed a dynamic proprioceptive test both with and without an ankle brace. The significance level was set at p ≤ 0.05. Results: Forty-one elderly individuals were categorized as having an increased risk for falling (X2 p-value: 2.65e -12). The proprioceptive unbraced performance of the increased fall risk (IRF: 2.9 ± 0.48) and poor fall risk (PRF: 2.97 ± 0.48) groups did not significantly differ (p > 0.05). The IRF group’s unbraced (2.9 ± 0.48) and braced proprioceptive (2.8 ± 0.45) scores did not significantly differ (p > 0.05). Finally, the PRF group braced (2.99 ± 0.46) and unbraced proprioceptive (2.97 ± 0.48) scores did not significantly differ (p > 0.005). There was a weak correlation between the dynamic proprioception and Fall Risk Index (r = 0.04). Conclusions: Ankle bracing did not enhance proprioception of the elderly.

The Effect of Knee Braces on Tibial Rotation in Anterior Cruciate Ligament – Deficient Knees During High Demand Athletic Activities

OBJECTIVE To examine if bracing can restrict tibial rotation in anterior cruciate ligament (ACL)-deficient patients during high loading activities. DESIGN Repeated measures. Kinematic data were collected with an 8-camera Vicon system while each patient performed 2 tasks that are known to cause increased rotational and translational loads on the knee: (1) descending from a stair and subsequent pivoting, and (2) landing from a platform and subsequent pivoting. The tasks were repeated under 3 brace conditions for the ACL-deficient knee: (1) wearing a prophylactic brace (braced condition), (2) wearing a patellofemoral brace (sleeved condition), and (3) without brace (unbraced condition). SETTING Biomechanical laboratory study. PATIENTS Twenty-one male subjects with a confirmed unilateral ACL rupture were assessed in vivo. MAIN OUTCOME MEASURES Tibial internal rotation. Two repeated measures ANOVAs tested for differences in tibial internal rotation among the 3 conditions of the ACL-deficient knee and the unbraced condition of the intact knee. RESULTS In both tasks, tibial rotation was significantly lower in the intact knee compared with all 3 conditions of the ACL-deficient knee (P ≤ 0.031). Bracing the ACL-deficient knee resulted in lower rotation than the unbraced (P ≤ 0.001) and sleeved (P ≤ 0.033) conditions. The sleeved condition resulted in lower tibial rotation in the drop landing and pivoting task compared with the unbraced condition (P = 0.019) but not in the stair descending and pivoting task (P = 0.256). CONCLUSIONS Bracing decreased the excessive tibial rotation in ACL-deficient patients during high-demand activities but failed to fully restore normative values. If knee braces can enhance rotational knee stability in ACL-deficient patients, then they could possibly play an important role in preventing further knee pathology in such patients.

Effects of Knee Bracing on Tibial Rotation During High Loading Activities in Anterior Cruciate Ligament–Reconstructed Knees

To test whether knee bracing restores normal rotational knee kinematics in anterior cruciate ligament (ACL)-reconstructed knees during high-demand, athletic activities. Twenty male patients who had undergone unilateral ACL reconstruction with a bone-patellar tendon-bone autograft were assessed in vivo. The mean time from surgery to data collection was 26 months (range, 25 to 28 months). An 8-camera optoelectronic system was used to collect kinematic data while each patient performed 2 demanding tasks: (1) immediate pivoting after descending from a stair and (2) immediate pivoting after landing from a platform. Each task was performed under 3 conditions for the reconstructed knee: (1) wearing a prophylactic brace (braced condition), (2) wearing a patellofemoral brace (sleeved condition), and (3) without a brace (non-braced condition). As a control group, patients with intact ACLs were tested without any bracing. This study protocol was identical to the protocol of a previous study that investigated the effect of bracing on ACL-deficient athletes. For both tasks, the range of motion of tibial rotation was significantly lower in the intact knee compared with all 3 conditions of the ACL-reconstructed knee (P ≤ .014). Placing a brace or a sleeve on the ACL-reconstructed knee resulted in lower rotation than the non-braced condition (P ≤ .022), whereas no significant differences were found between the sleeved and the braced conditions (P ≥ .110). Bracing limited the excessive tibial rotation in ACL-reconstructed knees during pivoting that occurs under high-demand activities. However, full restoration to normative values was not achieved. Thereby, braces have the potential to decrease rotational knee instability that still remains after ACL reconstruction.

The Effect of Knee Braces on Tibial Rotation in Anterior Cruciate Ligament–Deficient Knees During High-Demand Athletic Activities

To examine if bracing can restrict tibial rotation in anterior cruciate ligament (ACL)-deficient patients during high loading activities. Repeated measures. Kinematic data were collected with an 8-camera Vicon system while each patient performed 2 tasks that are known to cause increased rotational and translational loads on the knee: (1) descending from a stair and subsequent pivoting, and (2) landing from a platform and subsequent pivoting. The tasks were repeated under 3 brace conditions for the ACL-deficient knee: (1) wearing a prophylactic brace (braced condition), (2) wearing a patellofemoral brace (sleeved condition), and (3) without brace (unbraced condition). Biomechanical laboratory study. Twenty-one male subjects with a confirmed unilateral ACL rupture were assessed in vivo. Tibial internal rotation. Two repeated measures ANOVAs tested for differences in tibial internal rotation among the 3 conditions of the ACL-deficient knee and the unbraced condition of the intact knee. In both tasks, tibial rotation was significantly lower in the intact knee compared with all 3 conditions of the ACL-deficient knee (P ≤ 0.031). Bracing the ACL-deficient knee resulted in lower rotation than the unbraced (P ≤ 0.001) and sleeved (P ≤ 0.033) conditions. The sleeved condition resulted in lower tibial rotation in the drop landing and pivoting task compared with the unbraced condition (P = 0.019) but not in the stair descending and pivoting task (P = 0.256). Bracing decreased the excessive tibial rotation in ACL-deficient patients during high-demand activities but failed to fully restore normative values. If knee braces can enhance rotational knee stability in ACL-deficient patients, then they could possibly play an important role in preventing further knee pathology in such patients.

Basketball coaches' utilization of ankle injury prevention strategies.

Background:Ankle injuries are the most common high school basketball injury. Little is known regarding the utilization of ankle injury prevention strategies in high school settings.Objective:To determine high school basketball coaches’ utilization of ankle injury prevention strategies, including prophylactic ankle bracing (PAB) or an ankle injury prevention exercise program (AIEPP).Study Design:Cross-sectional survey.Methods:The survey was distributed to all high school basketball coaches in Wisconsin. Fisher exact and Wilcoxon rank sum tests were used to determine if the injury prevention strategies utilized differed according to school size, sex of the team, years of coaching experience, and the coach’s education level.Results:Four hundred eighty (55%) coaches from 299 (74%) high schools completed the survey. Thirty-seven percent of the coaches encouraged or required their players to use PAB. School enrollment of the coaches’ teams did not affect their stance on the use of PAB (P = 0.30), neither did the sex of the team (P = 0.16), years coaching (P = 0.09), nor the coach’s education (P = 0.49). Fifty percent (n = 242) of the coaches indicated they do not utilize an AIEPP, with no difference based on school enrollment (P = 0.47), team sex (P = 0.41), years coaching (P = 0.78), or the education level (P = 0.44). Barriers to utilization of AIEPP included a lack of time, awareness, and expertise. Coaches preferred an AIEPP that was specific to basketball, combined injury prevention and performance enhancement components, was performed 2 to 3 days per week, and lasted 5 to 15 minutes.Conclusion:Less than half of the coaches encouraged use of PAB, and half did not utilize an AIEPP. Coaches had specific preferences for the type of AIEPP they would implement.Clinical Relevance:Sports medicine providers should promote ankle injury prevention strategies but need to address why prevention strategies may not be utilized in high school basketball settings.

The Effectiveness of Prophylactic Ankle Braces in Reducing the Incidence of Acute Ankle Injuries in Adolescent Athletes: A Critically Appraised Topic

Ankle injuries constitute a large number of injuries sustained by adolescent athletes participating in high school athletics. Prophylactic ankle bracing may be an effective and efficient method to reduce the incidence of ankle injuries in adolescent athletes in the secondary-school setting. Do prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes? Two of the three included studies reported that prophylactic ankle braces reduced the incidence of ankle injuries compared with no ankle bracing. There is moderate evidence to support the use of prophylactic ankle braces in adolescent athletes, particularly those who participate in football and basketball, to reduce the incidence of acute ankle injuries. Grade B evidence exists that prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes.

Does Wearing a Prophylactic Ankle Brace During Drop Landings Affect Lower Extremity Kinematics and Ground Reaction Forces?

The objective of the study was to determine if prophylactic ankle bracing worn by females during landings produces abnormal lower extremity mechanics&period; Angular kinematic and ground reaction force &lpar;GRF&rpar; data were obtained for 16 athletically experienced females who performed brace and no-brace drop landings&period; The brace condition displayed reduced in&sol;external rotation and flexion displacements about the ankle and knee joints and increased vertical and mediolateral GRF peak magnitudes and rate of vertical GRF application &lpar;paired t test&comma; P &lt; &period;05&rpar;&period; The ankle and knee joints landed in a less plantar flexed and more flexed position&comma; respectively&period; No significant ab&sol;adduction outcomes may have occurred due to interparticipant variability and&sol;or a lack of brace restriction&period; Conclusion&colon; During typical landings&comma; this lace-up brace increases vertical GRF&comma; decreases ankle and knee joint displacements of flexion and int&sol;external rotation&comma; but minimally affects ab&sol;adduction displacements&period;

Effect of Ankle Braces on Lower Extremity Joint Energetics in Single-Leg Landings

Ankle sprains are one of the most common injuries in competitive and recreational athletics. Studies have shown that the use of prophylactic ankle braces effectively reduces the frequency of ankle sprains in athletes. However, although it is generally accepted that the ankle braces are effective at reducing frontal plane motion, some researchers report that the design of the brace may also reduce ankle sagittal plane motion. The purpose of this study was to quantify lower extremity joint contributions to energy absorption during single-legged drop landings in three ankle brace conditions (no brace, boot brace, and hinged brace). Eleven physically active females experienced in landing and free of lower extremity injury (age = 22.3 ± 1.7 yr, height = 1.66 ± 0.04 m, mass = 58.43 ± 5.83 kg) performed 10 single-leg drop landings in three conditions (one unbraced, two braced) from a 0.33-m height. Measurements taken were hip, knee, and ankle joint impulse; hip, knee, ankle, and total work; and hip, knee, and ankle joint relative work. Total energy absorption remained consistent across the braced conditions (P = 0.057). Wearing the boot brace reduced relative ankle work (P = 0.04, Cohen d = 0.43) but did not change relative knee (P = 0.08, Cohen d = 0.32) or hip (P = 0.14, Cohen d = 0.20) work compared with the no-brace condition. In an ankle-braced condition, ankle, knee, and hip energetics may be altered depending on the design of the brace.

The Effects of Prophylactic Ankle Bracing on Dynamic Reach Distance and Obstacle Course Performance in Military Cadets

Ankle braces can protect the ankle joint from ligament sprains and fractures during high-risk military activities such as physical training and parachuting. Although braces are recommended for injury prevention purposes, the impact of braces on physical performance is unknown. This study evaluated lace-up ankle braces, worn inside the boots, across three conditions: no brace, unilateral brace, and bilateral brace on the dependent variables of dynamic lower extremity reach and obstacle course performance. Thirty-seven military cadets were tested over 3 days. Ankle bracing had a small effect upon anterior and composite lower extremity reach distances. Bracing had no effect upon obstacle course performance times. Inside-the-boot ankle bracing restricts lower extremity reaching and mildly impacts mobility, however, no restrictions were observed with running, climbing, jumping, or negotiating obstacles. Lace-up ankle braces can be used in conjunction with combat boots to protect the ankle during high-risk activities without having an impact upon tactical movements.

Rationale of Revision Lumbar Spine Surgery

Revision lumbar spine surgeries are technically challenging with inconstant outcome results. This article discusses the preoperative, intraoperative, as well as postoperative management in these difficult patients. Successful intervention requires a detailed history and physical examination and carefully chosen diagnostic tests. Preoperative planning is paramount in these cases. The decision-making process should address the timing of the surgery, surgical approach, level of interbody fusion required, correction of sagittal imbalance, type of osteotomy, location of the osteotomy, and the end of the construct. Surgeons should be prepared to manage associated complications such as dural tear and massive blood loss. The use of autograft and/or biologic graft is necessary to help in achieving a successful fusion. Postoperative management includes prophylactic antibiotic, anticoagulation, nutritional support, and brace.

The Effect of Prophylactic Ankle Braces on Lower Extremity Joint Energetics During Single Leg Landings

The Effect of Prophylactic Ankle Braces on Lower Extremity Joint Energetics During Single Leg Landings

Intrinsic risk factors and the effects of prophylactic bracing on the development of patellofemoral pain in male subjects

BackgroundThe aetiology of patellofemoral pain (PFP) is multifactorial. Patellofemoral bracing can be used as a preventative method in subjects undergoing strenuous training.ObjectiveIndividuals with intrinsic risk factors for PFP could be...

Knee braces can decrease tibial rotation during pivoting that occurs in high demanding activities

The purpose of this study was to investigate whether knee braces could effectively decrease tibial rotation during high demanding activities. Using an in vivo three-dimensional kinematic analysis, 21 physically active, healthy, male subjects were evaluated. Each subject performed two tasks that were used extensively in the literature because they combine increased rotational and translational loads on the knee, (1) descending from a stair and subsequent pivoting and (2) landing from a platform and subsequent pivoting under three conditions: (A) wearing a prophylactic brace (braced), (B) wearing a patellofemoral brace (sleeved), and (C) unbraced condition. In the first task, tibial rotation during the pivoting phase was significantly decreased in the braced condition as compared to the sleeved condition (P = 0.019) and the non-braced condition (P = 0.002). In the second task, the same variable was significantly decreased in the braced condition as compared to the sleeved (P = 0.001) and the unbraced condition (P < 0.001). The sleeved condition also produced significantly decreased tibial rotation with respect to the unbraced condition (P = 0.021). Bracing decreased tibial rotation in activities where increased translational and rotational forces were applied. Because knee braces decreased tibial rotation, they can possibly be used with ACL-reconstructed and ACL-deficient patients to prevent such problems. Case-control study, Level III.

The Effectiveness of Prophylactic Knee Bracing in American Football

Context:Knee injuries, particularly of the medial collateral ligament (MCL), are the most common injury sustained in American football. In 1979, Anderson et al described a knee brace that could protect uninjured knees from MCL injuries resulting from lateral impact. Since then, a number of light and free-moving bracing devices have been developed. However, the efficacy of prophylactic knee bracing remains in question.Objective:A systematic review of the efficacy of prophylactic knee bracing in preventing MCL injuries in football players.Data Sources:Based on MedSearch and PubMed, articles from 1985 to November 2009 were identified with the following keywords and their combinations: prophylactic, prevent injury, knee brace, prevention, medial collateral ligament, MCL, football, and bracing.Study Selection:One randomized controlled trial (level 1 study) and 5 prospective cohort studies (level 2 studies) were selected.Results:The results of the studies were inconsistent; only 1 study showed that prophylactic knee bracing significantly reduced MCL injuries (P < .05). In contrast, 2 studies found that knee bracing was associated with an increase in knee injuries.Conclusions:Prophylactic bracing in American football has not consistently reduced MCL injuries. There remains a lack of evidence to support the routine use of prophylactic knee bracing in uninjured knees. There is limited high-level evidence, bias in the available literature, and confounding variables that limit the current literature.

Management of Medial Collateral Ligament Injuries in the Knee: An Update and Review

The medial collateral ligament (MCL) is the most frequently injured ligament in the knee, with mild-to-moderate tears often going unreported to physicians. Medial collateral ligament injuries can result from both contact and noncontact sporting activities. The mainstay of treatment is nonoperative; however, operative management of symptomatic grade II and grade III injuries is considered when laxity and instability persist. The timing of surgical repair in the setting of a multiligament knee injury remains an area of controversy among surgeons, with proponents of early reconstruction of the anterior and posterior cruciate ligaments and nonoperative management of the MCL versus proponents of delayed reconstruction following nonoperative treatment of the MCL. Prophylactic bracing may continue to increase and evolve as bracing technology improves and athletic cultures change.

Prophylactic Ankle Brace Use in High School Volleyball Players: A Prospective Study

The purpose of this study was to determine the effect of prophylactic ankle bracing on the incidence of ankle injuries in a high school population of interscholastic volleyball players followed prospectively for one season. The study was designed to evaluate the effect of different types of ankle braces on the incidence of ankle sprains in high school volleyball players. There were 957 players in the group that wore braces and 42 in the control group who did not wear a brace. Information was collected on age, sex, previous injury, incidence of injury, and time off from play. Only the dominant ankle was studied. Overall, the use of a prophylactic ankle brace did not significantly alter the incidence of ankle sprains in high school volleyball players. However, in players without a previous ankle sprain, the use of an ankle brace did make a significant difference in two of the braced groups. The Active Ankle Trainer II and the Aircast Sports Stirrup protected volleyball players from a sprain only if they had not had a previous sprain. If the player had a history of a previous ankle sprain, these two brace groups did not protect the ankle from another ankle sprain (p < 0.05). In addition, there were significantly more injuries in the female group of players who wore a non-rigid brace versus those who wore a more rigid brace. This information may be helpful in deciding whether to recommend prophylactic ankle braces in volleyball players.

A study of semi-rigid support on ankle supination sprain kinematics

Ankle sprain injury is very common in sports and the use of ankle support is crucial. This research investigated the effect of an ankle brace in reducing the ankle angular displacement and angular velocity during sudden supination. In the experiment, 11 healthy males were tested. The bracing condition, semi-rigid ankle braces were investigated. The angular displacement and angular velocity of the ankle were computed. The motion-capture system was adopted to capture the three-dimensional coordinates of the reflective markers. The coordinates of the reflective markers were used to compute the ankle kinematics during simulated ankle supination. A mechanical supination platform was used to simulate the sprain motions. Experimental results showed that the semi-rigid brace tested significantly reduced the ankle angular displacement and angular velocity compared with control conditions during sudden supination. In conclusion, the semi-rigid-type brace can provide significant restriction to reduce the magnitudes of the angular displacement and angular velocity of the ankle during sudden supination sprain. The semi-rigid-type brace is suggested as the prophylactic bracing for the ankle.

Lower Extremity Kinematics and Ground Reaction Forces After Prophylactic Lace-Up Ankle Bracing

Lower Extremity Kinematics and Ground Reaction Forces After Prophylactic Lace-Up Ankle Bracing