Hello dear all,

Thank you for your interest in this topic. I`m
summarizing the answers I got on the topic of
"Functional Knee Bracing after complete ACL tearing"

My questions were:

1)Is there any empirical support to show the effects
> of Functional Knee Brace on proprioceptive or motor
> control strategy in people with torn ACL? Any
> literature available?
> 2)What are the effects of Functional Knee Brace on
> balance and posture of these patients?
> 3) The instrument we want to use is the Biodex
> system, is there any other instrument suitable for
> this reason? or any valid questionnaire?


Anne Benjaminse, PT

1: Harilainen A, Sandelin J.
Post-operative use of knee brace in bone-tendon-bone
patellar tendon anterior cruciate ligament
reconstruction: 5-year follow-up results of a
randomized prospective study.Scand J Med Sci Sports.
2006 Feb;16(1):14-8. PMID: 16430676 [PubMed - in

2: Swirtun LR, Jansson A, Renstrom P.
The effects of a functional knee brace during early
treatment of patients with a nonoperated acute
anterior cruciate ligament tear: a prospective
randomized study.Clin J Sport Med. 2005
Sep;15(5):299-304. PMID: 16162987 [PubMed - indexed

3: Smith J, Malanga GA, Yu B, An KN.
Effects of functional knee bracing on muscle-firing
patterns about the chronic anterior cruciate
ligament-deficient knee.Arch Phys Med Rehabil. 2003
Nov;84(11):1680-6.PMID: 14639570 [PubMed - indexed for

4: Mallory N, Kelsberg G, Ketchell D, Lord JL.
Clinical inquiries. Does a knee brace decrease
recurrent ACL injuries? J Fam Pract. 2003
Oct;52(10):803-4. Review. No abstract available.
PMID: 14529607 [PubMed - indexed for MEDLINE]

5: Melegati G, Tornese D, Bandi M, Volpi P,
Schonhuber H, Denti M.The role of the rehabilitation
brace in restoring knee extension after anterior
cruciate ligament reconstruction: a prospective
controlled study.Knee Surg Sports Traumatol Arthrosc.
2003 Sep;11(5):322-6. Epub 2003 Jul 16.
PMID: 12879225 [PubMed - indexed for MEDLINE]

6: Decoster LC, Vailas JC.
Functional anterior cruciate ligament bracing: a
survey of current brace prescription patterns.
Orthopedics. 2003 Jul;26(7):701-6; discussion 706.
PMID: 12875565 [PubMed - indexed for MEDLINE]

7: Kocher MS, Sterett WI, Briggs KK, Zurakowski D,
Steadman JR. Effect of functional bracing on
subsequent knee injury in ACL-deficient professional
skiers.J Knee Surg. 2003 Apr;16(2):87-92.
PMID: 12741421 [PubMed - indexed for MEDLINE]

8: Lam RY, Ng GY, Chien EP. Does wearing a functional
knee brace affect hamstring reflex time in
subjects with anterior cruciate ligament deficiency
during muscle fatigue? Arch Phys Med Rehabil. 2002
Jul;83(7):1009-12. PMID: 12098163 [PubMed - indexed

9: Beynnon BD, Good L, Risberg MA.
The effect of bracing on proprioception of knees with
anterior cruciate ligament injury.
J Orthop Sports Phys Ther. 2002 Jan;32(1):11-5.
PMID: 11787904 [PubMed - indexed for MEDLINE]

10: Rebel M, Paessler HH.
The effect of knee brace on coordination and neuronal
leg muscle control: an early postoperative functional
study in anterior cruciate ligament
reconstructed patients.
Knee Surg Sports Traumatol Arthrosc. 2001
PMID: 11685358 [PubMed - indexed for MEDLINE]

11: Birmingham TB, Kramer JF, Kirkley A, Inglis JT,
Spaulding SJ, Vandervoort AA.
Knee bracing after ACL reconstruction: effects on
postural control and proprioception.
Med Sci Sports Exerc. 2001 Aug;33(8):1253-8.
PMID: 11474323 [PubMed - indexed for MEDLINE]

12: Rebel M, Passler HH.
[Effects of knee braces on sensorimotor capabilities
of patients with ACL reconstruction]
Sportverletz Sportschaden. 2001 Mar;15(1):16-21.
PMID: 11338659 [PubMed - indexed for MEDLINE]

13: Wu GK, Ng GY, Mak AF.
Effects of knee bracing on the functional performance
of patients with anterior cruciate ligament
Arch Phys Med Rehabil. 2001 Feb;82(2):282-5.
PMID: 11239327 [PubMed - indexed for MEDLINE]

14: Risberg MA, Beynnon BD, Peura GD, Uh BS.
Proprioception after anterior cruciate ligament
reconstruction with and without bracing.
Knee Surg Sports Traumatol Arthrosc. 1999;7(5):303-9.
PMID: 10525700 [PubMed - indexed for MEDLINE]

15: Martinek V, Friederich NF.
[To brace or not to brace? How effective are knee
braces in rehabilitation?]
Orthopade. 1999 Jun;28(6):565-70. Review. German.
PMID: 10431312 [PubMed - indexed for MEDLINE]

16: Ramsey DK, Wretenberg PF, Lamontagne M, Nemeth G.

Electromyographic and biomechanic analysis of
anterior cruciate ligament deficiency and functional
knee bracing.
Clin Biomech (Bristol, Avon). 2003 Jan;18(1):28-34.
PMID: 12527244 [PubMed - indexed for MEDLINE]

17: Acierno SP, D'Ambrosia C, Solomonow M, Baratta
RV, D'Ambrosia RD. Electromyography and biomechanics
of a dynamic knee brace for anterior cruciate
ligament deficiency.
Orthopedics. 1995 Nov;18(11):1101-7. Review.
PMID: 8559695 [PubMed - indexed for MEDLINE]

18: Branch TP, Hunter R, Donath M.
Dynamic EMG analysis of anterior cruciate deficient
legs with and without bracing during cutting.
Am J Sports Med. 1989 Jan-Feb;17(1):35-41.
PMID: 2929835 [PubMed - indexed for MEDLINE]

19: Beynnon BD, Fleming BC, Churchill DL, Brown D.
The effect of anterior cruciate ligament deficiency
and functional bracing on translation of the tibia
relative to the femur during nonweightbearing
and weightbearing.
Am J Sports Med. 2003 Jan-Feb;31(1):99-105.
PMID: 12531765 [PubMed - indexed for MEDLINE]

20: Wojtys EM, Kothari SU, Huston LJ.
Anterior cruciate ligament functional brace use in
Am J Sports Med. 1996 Jul-Aug;24(4):539-46.
PMID: 8827316 [PubMed - indexed for MEDLINE]

21: Ramsey DK, Lamontagne M, Wretenberg PF, Valentin
A, Engstrom B,Nemeth G. Assessment of functional knee
bracing: an in vivo three-dimensional kinematic
analysis of the anterior cruciate deficient knee.
Clin Biomech (Bristol, Avon). 2001 Jan;16(1):61-70.
PMID: 11114445 [PubMed - indexed for MEDLINE]

22: Beynnon BD, Ryder SH, Konradsen L, Johnson RJ,
Johnson K, Renstrom PA.
The effect of anterior cruciate ligament trauma and
bracing on knee proprioception.
Am J Sports Med. 1999 Mar-Apr;27(2):150-5.
PMID: 10102093 [PubMed - indexed for MEDLINE]

23: McDevitt ER, Taylor DC, Miller MD, Gerber JP,
Ziemke G, Hinkin D, Uhorchak JM, Arciero RA, Pierre
Functional bracing after anterior cruciate ligament
reconstruction: a prospective, randomized, multicenter
Am J Sports Med. 2004 Dec;32(8):1887-92.
PMID: 15572317 [PubMed - indexed for MEDLINE]

24: Lu TW, Lin HC, Hsu HC.
Influence of functional bracing on the kinetics of
anterior cruciate ligament-injured knees during level
Clin Biomech (Bristol, Avon). 2006 Feb 20; [Epub ahead
of print]
PMID: 16494979 [PubMed - as supplied by publisher]

25: Bagger J, Ravn J, Lavard P, Blyme P, Sorensen C.
Effect of functional bracing, quadriceps and
hamstrings on anterior tibial translation in anterior
cruciate ligament insufficiency: a preliminary
J Rehabil Res Dev. 1992 Winter;29(1):9-12.
PMID: 1740779 [PubMed - indexed for MEDLINE]
Associate Professor and Director of Research
Orthopedics and Rehabilitation
College of Medicine, University of Vermont

Yes, there are several publications that have focused
on the effect of the functional knee braces on
proprioception and motor control strategies (I have
published some of this, and a medline search on my
name will reveal this work). There has also been
research on the effect of braces on postural control;
however, I am not sure how to interpret this outcome.
In the past, I have used the Biodex Balance system,
but I have found that this device is has not been
validated and it is unclear what it actually measures
(I went back and forth with this company for
some time and finally returned the system to them)...
You could measure postural sway with a force
platform, but as I mentioned I am not sure how useful
this outcome is.

Katherine S. Rudolph from Department of Physical
Therapy, University of Delaware has also conducted
some reseach studies as follow:

Schmitt, L.C. , Schmitt, L.A., Rudolph, K.S.
Management of Patient with a Forearm Fracture and
Median Nerve Injury. J Orthop Sport Phys Ther. 2004

Lewek, M., Rudolph, K.S., Snyder-Mackler, L.
Quadriceps Femoris Muscle Weakness and Activation
Failure in Patients With Symptomatic Knee
Osteoarthritis. Journal of Orthopaedic Research.
2004 Jan;22(1):110-5.

Chmielewski, T.L., Rudolph K.S., Snyder-Mackler, L.
Development of Dynamic Knee Stability after Acute ACL
Injury. J Electromyogr Kinesiol. 2002

Lewek, M., Rudolph, K.S., Axe, M.J., Snyder-Mackler,
L. The effect of insufficent quad strength on giat
after anterior cruciate ligament reconstruction. Clin
Biomech 2002 Jan, 17(1):56-63.

Williams, G.N., Chmielewski, T.L., Rudolph, K.S.,
Buchanan, T.S., Snyder-Mackler, L. Dynamic knee
stability: Current theory and implications for
clinicians and scientists. J Orthop Sports Phys Ther,
2001 Oct;31(10):546-66).

Chmielewski, T.L., Rudolph, K.S., Fitzgerald, G.K.,
Axe, M.J., Snyder-Mackler, L. Biomechanical Evidence
Supporting a Differential Response to Acute ACL
Injury. Clinical Biomechanics. 2001

Rudolph K.S., Axe, M.J., Buchanan, T.S., Scholz, J.P.,
Snyder-Mackler, L. Dynamic Stability in the ACL
deficient knee. Knee Surg Sports Traumatol Arthrosc.

Rudolph K.S., Axe, M.J., Snyder-Mackler, L. Dynamic
Stability in the ACL deficient knee: Who can hop?
Knee Surg Sports Traumatol Arthrosc. 2000;8(5):262-9

Rudolph, K.S.; Eastlack, M.E.; Axe, M.J.;
Snyder-Mackler, L. 1998 Basmajian Student Award Paper:
Movement patterns after anterior cruciate ligament
injury: a comparison of patients who compensate well
for the injury and those who require operative
stabilization. J Electromyogr Kinesiol, 8(6):
349-362, 1998.

Kind Regards,

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