Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain

Tomescu, Sebastian; Bakker, Ryan; Wasserstein, David; Kalra, Mayank; Nicholls, Micah; Whyne, Cari; Chandrashekar, Naveen

doi:10.1007/s00167-017-4794-1

Cited by 9 publications

(10 citation statements)

References 39 publications

(61 reference statements)

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“…9–14 However, in vitro studies did demonstrate that bracing could protect the ACL and medial collateral ligament against lateral impacts. 15,16 Furthermore, a study by Tomescu et al 17 supported the use of a brace with a dynamic tensioning system for ACL-deficient knees.…”

Section: Introductionmentioning

confidence: 97%

The effect of knee brace misalignment on the anterior cruciate ligament

Hacker¹,

Schall²,

Ignatius³

et al. 2019

Prosthetics &Amp; Orthotics International

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Background: Protective knee braces are used for rehabilitation or prevention. Due to poor patient compliance or slippage, the brace might be misaligned with the knee axis. Objectives: Does a misaligned knee brace stress the anterior cruciate ligament? Study design: It is an experimental study. Methods: A strain sensor was implanted on the anterior cruciate ligament in eight limbs. The limbs were mounted in a knee simulator, muscle forces were applied and a cyclic motion from 10° to 60° flexion was performed under three conditions: unbraced, braced and with a misaligned brace. Outcome measures: The outcome measures were anterior cruciate ligament strain and three-dimensional kinematics of the knee joint. Results: The correctly aligned brace significantly reduced the anterior cruciate ligament strain at 10° compared to the unbraced condition from 0% to −1.54% (standard deviation = 1.4). The misaligned brace neutralised the effect of bracing to −0.06% (standard deviation = 1.1) anterior cruciate ligament strain. At 60° flexion angle, bracing had no statistically significant effect on the anterior cruciate ligament strain compared to the unbraced knee: −2.58% (standard deviation = 0.8) versus −1.64% (standard deviation = 1.0). The anterior cruciate ligament in the misaligned braced knee at 60° flexion with a strain of −1.1% (standard deviation = 0.9) was significantly more stressed than in the correctly aligned condition. An effect of bracing on knee kinematics was not detected. Conclusion: A correctly aligned knee brace reduced anterior cruciate ligament strain. By contrast, a misaligned brace tended to increase the anterior cruciate ligament strain compared to the unbraced knee. Clinical relevance The correct alignment of the brace was identified as a key factor decisively influencing the effectiveness of bracing.

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Section: Introductionmentioning

confidence: 97%

The effect of knee brace misalignment on the anterior cruciate ligament

Hacker¹,

Schall²,

Ignatius³

et al. 2019

Prosthetics &Amp; Orthotics International

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“…In the operation room, the knee was immobilized with a brace with the knee positioned in 20° of flexion for both groups to maintain the same angle as during graft fixation at surgery to avoid excess stress on the grafts [32]. In this study, the knee functional brace was employed for prophylaxis of re-injury or in protecting the ACL graft following reconstruction [33]. After the protocol immobilization period, active and passive range of motion exercises were performed gradually with a functional brace (BREG X2K brace, BREG, CA, USA) (Fig.…”

Section: Methodsmentioning

confidence: 99%

Early weight-bearing after anterior cruciate ligament reconstruction with hamstring grafts induce femoral bone tunnel enlargement: a prospective clinical and radiographic study

Tajima

Yamaguchi

Nagasawa

et al. 2019

BMC Musculoskelet Disord

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Background Bone tunnel enlargement following primary anterior cruciate ligament (ACL) reconstruction with soft tissue graft might be a severe disadvantage for revision surgery. The postoperative rehabilitation protocol including the non-weight-bearing periods were different depending on the surgeon or institute. To determine the relationship between femoral bone tunnel enlargement and the postoperative non-weight-bearing period after double-bundle ACL reconstruction with hamstring grafts. Methods Forty-two patients who underwent primary double-bundle ACL reconstruction with hamstring grafts were divided into two postoperative non-weight-bearing protocol groups: 1-week non-weight-bearing postoperatively (group A, n = 19); and 2-week non-weight-bearing (group B, n = 18). Five cases were excluded due to additional knee injury, pregnancy, and lost to follow-up. Bone tunnel enlargement was evaluated by computed digital radiographs (anteroposterior (A-P) and lateral views) taken on the first postoperative day and at 12 months. Each tunnel diameter was shown as a percentage to the maximum joint width of the proximal tibia in the A-P view, or a percentage of the maximum diameter of the patella in the lateral view. To determine the incidence of tunnel enlargement, percentage diameter changes of more than 10% were defined as an enlarged tunnel. The magnitude of tunnel enlargement and the standard clinical evaluation were also evaluated. Results There were no significant differences between groups in the incidences of anteromedial and posterolateral bone tunnel enlargement, both in the A-P and lateral views (2 × 2 Chi-squared test). The magnitude of femoral posterolateral bone tunnel enlargement was significantly greater in group A in the A-P view ( p = 0.01) and lateral view ( p = 0.03) (Mann Whitney U-test). Twelve months after surgery, the Lysholm score and Tegner activity level scale were not significantly different between the groups. Conclusions This prospective, clinical and radiographical study showed that early weight-bearing protocol after double-bundle ACL reconstruction with hamstring grafts might have the potential risk of significant postoperative femoral bone tunnel enlargement of the posterolateral bundle. There was no significant difference in clinical outcomes by postoperative non-weight-bearing period. To reduce and prevent the femoral bone tunnel enlargement, the comprehensive management could be considered and required to establish the suitable early stage rehabilitation protocol after surgery. Trial registration Trial registration number; UMIN000036212 . Scientific title: Prospective comparisons of femoral tunnel enlargement with two different postoperative non weight bearing periods after double-bundle anterior c...

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“…30,35 Ten fresh-frozen unpaired cadaver knees (5 male and 5 female, age: 49.7 ± 8.4 years and body mass index (BMI): 21.5 ± 6.0) were procured from a body donor program and were prepared for experimental testing based on previously developed methodologies. [24][25][26] Initially, a negative mould of the frozen knee was prepared. The knees were thawed and subsequently the skin, subcutaneous tissue and muscle bodies were dissected leaving all ligaments and major muscle tendons intact.…”

Section: Methodsmentioning

confidence: 99%

“…The participant was instructed to perform the activities at a natural pace, resulting in a walking speed of 1.9 steps/s and a 2LS and 1LS with maximum flexion angles of 83° and 81° in 1.8 s, respectively. 26 Walking is a necessary mobility function of any healthy individual; whereas, 2LS and 1LS are early and late injury rehabilitation exercises in most recovery programmes. 27 A total of 36 body markers were placed on anatomical landmarks in regions including the thorax, pelvis, upper leg, lower leg and feet.…”

Section: Methodsmentioning

confidence: 99%

“…The RC brace is designed to apply a larger valgus moment than the UF brace. A combined in vivo, in silico and in vitro dynamic approach developed by previous works [23][24][25][26] is used in this study to investigate three activities of typical daily living including a two-legged squat (2LS), one-legged squat (1LS) and walk (WLK). This study hypothesizes the following: i. Unloader knee braces decrease the strain in the medial meniscus during dynamic activities.…”

Section: Introductionmentioning

confidence: 99%

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The effect of unloader knee braces on medial meniscal strain

Kalra

Bakker

Tomescu

et al. 2019

Prosthetics &Amp; Orthotics International

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Two unloader knee braces effectively reduced strain in the medial meniscus with an intact anterior cruciate ligament during dynamic activities. Neither brace made a significant reduction in strain for anterior cruciate ligament-deficient knees. Clinical relevance Unloader knee braces could be used to reduce the medial meniscus strain following meniscal surgery and during rehabilitation in patients with an isolated medial meniscus injury. However, these braces cannot be recommended for this purpose in patients with an anterior cruciate ligament deficiency.

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Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain

Abstract: II.

Cited by 9 publications

References 39 publications

The effect of knee brace misalignment on the anterior cruciate ligament

The effect of knee brace misalignment on the anterior cruciate ligament

Early weight-bearing after anterior cruciate ligament reconstruction with hamstring grafts induce femoral bone tunnel enlargement: a prospective clinical and radiographic study

The effect of unloader knee braces on medial meniscal strain

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