Functional ACL Bracing: A Survey of Current Opinion and Practice

Introduction: The purpose of this study was to survey orthopaedic sports medicine specialists regarding their ACL bracing practices. The role of functional knee bracing for anterior cruciate ligament (ACL) deficiency, or after reconstruction, is still unclear. In general, subjective data supports the use and benefits of functional braces. Conversely, objective data shows failure of braces to control anterior tibial translation at physiologic loads (>400 Newtons). Without clear scientific data to determine prescription parameters for bracing, it is useful to know how other physicians actually use ACL braces.

Methods: Surveys were mailed twice to the 1,200 US members of the AOSSM. The data were analyzed descriptively and inferentially. Differences in bracing percentages were compared using the Wilcoxon Signed Ranks Test, and regionalized responses were compared using the Kruskall-Wallis Test. Bonferroni-adjusted p value was set at .05/11 or .0045.

Results: The survey data of 287 (24%) respondents were analyzed. The only statistically significant finding was that doctors prescribe off-the-shelf (OTS) braces more frequently for deficient patients (D) than for reconstructed patients (R) (p=0.000). There was no difference in the overall pattern of prescription of functional braces for D versus R (p=.529), nor in the pattern of prescription of custom braces (p=.083). The frequency of responses indicating that a doctor never uses functional braces was higher for R, with 36/282 (12.8%) saying they never prescribe a functional brace, while for D, only 8/285 (2.8%) said they never brace. In deciding whether to brace or which brace to prescribe, 60% of respondents said the patient’s activity level was the most important factor to consider for both D and R. There was no difference in the use of functional braces by geographic region. Finally, regarding change in practice over the past five years, 139 doctors said they’re bracing D less frequently and 146 said they’re bracing R less frequently. Only 4 (D) and 5 (R) said they’re bracing more frequently, while 73 (D and R) said their bracing practices were unchanged.

Conclusions: Most AOSSM doctors surveyed use functional braces for both D and R. If the doctors will leave a patient unbraced, it is more likely to be a reconstructed patient. The patients’ activity level is most important to these doctors when they are making brace decisions. There is no regional difference in brace prescription patterns. The most common change in practice over the past five years is that the doctors are bracing less frequently.

2000 Decoster LC, Vailas JC: ACL Bracing: A Survey of Current Opinion and Practice. (Abstract)" J Athletic Training, Vol 35 Suppl