ACL repaired knee w/o a brace?

[Stymie]

I have two reconstructed knees... and two Donjoy defiance braces. I really hate skiing with the braces. I would love to ditch them and ski au natural. Anyone have any thoughts one way or another?

[Mofro261]

How long since surgery and rehab? They have diminished value the further out you are. If your legs are strong no reason to keep using the braces since they flat out won't prevent re-tear of an ACL, but do prevent hyperextension and have some value to protect against lateral impacts. Still need psychological support? Try a simple neoprene sleeve brace, it will stabilize your knee a bit and keep it warmer, and may be more comfortable than the donjoy.

[Stymie]

How long since surgery and rehab? They have diminished value the further out you are. If your legs are strong no reason to keep using the braces since they flat out won't prevent re-tear of an ACL, but do prevent hyperextension and have some value to protect against lateral impacts. Still need psychological support? Try a simple neoprene sleeve brace, it will stabilize your knee a bit and keep it warmer, and may be more comfortable than the donjoy.

20 years for one knee- very little meniscus left in this one...
2 years for the other

legs are fairly strong- always spend the fall working on the legs to get them in ski shape.

I play squash and racquetball without the braces... so I would think skiing would be similar.

Also, I was under the impression that these custom braces did reduce the chances of a re-tear. No?

[Dexter Rutecki]

I don't believe it's possible for a brace to restrict the relatively small movement between femur and tib that could cause a tear.

I've had three ACL recons and never skied with a brace, and was never advised to do so. When I taught tennis 3-4 months after my first knee surgery (not recon) I did wear a brace, but ditched it pretty soon when it became clear to me it was useless.

But as with everything else here, do what your ortho tells you.

[drmark]

A report in last year's American Journal of Sports Medicine revealed that the rate of long term knee stability in those reconstructed patients who were braceless was the same as those who were braced.

[dickGRUNKE]

I was looking at a brace like the Asterisk Cell. I am 23 have fairly healthy knees (small medial meniscus tear on right and bilateral chondromalacia of patella) I wasn't sure if a heavy duty brace would reduce the risk of further damage to the menisci. Sorry I don't mean to steal the thread with my own question.

[Stymie]

A report in last year's American Journal of Sports Medicine revealed that the rate of long term knee stability in those reconstructed patients who were braceless was the same as those who were braced.

so do you advice your patients to ditch the brace post one year if they want to?

[drmark]

I tell my patients what the literature says and I let them decide if they want a sports brace. If it were my knee, I would spend the money on my kids.

A post op brace is a complete waste of time and I never use them. It usually builds in a flexion contracture of the knee.

[montanaskier]

I tore my ACL last December and had surgery in Jan. I am currently only skiing with a neoprene(sp) brace. However I forgot it today and skied all day without issue. I have no doubt that my silly brace does nothing but it makes me feel better. That being said, I think I may go braceless from here on out.

[mtnbikerskierchick]

12 yrs ago I had ACL repair and skied for a couple of years on a CTI brace. Finally, I felt confident enough to ditch it and it's been fine ever since, despite multiple ragdolls down mountains, cliff jumps, etc. Tore my other ACL last year, have a knee brace this year, but will likely ditch it next season...

[altagirl]

I tell my patients what the literature says and I let them decide if they want a sports brace. If it were my knee, I would spend the money on my kids.

What about when insurance pays for the sports braces? (For some inexplicable reason, my insurance wouldn't pay for the post-op brace I woke up in - and therefore didn't get asked if I wanted it or not..., but paid 100% for my sports knee braces. Go figure...)

Anyway, FWIW - I skied with 1 defiance for a few years, then 2 defiances after an ACL reconstruction in my other knee. Today I experimented with not wearing them and felt pretty good - but I was also just cruising groomers (since everything else is a minefield of rocks and stumps), and it felt pretty good. But I still plan on wearing them riding my dirt bike permanently.

[drmark]

It really does't matter who pays for it. The medical literature doens't support it's use. People hold their braces as close to them as others hold their intrepretation of the Holy Bible, so this conversation is likely to cause much consternation.

[Dexter Rutecki]

Based on what every doc I've spoken to at the top bone and joint places in NYC (and probably everywhere else) says I'm with drmark on this one. Braces don't help protect ACL's, and based on the brief time I wore one they could inhibit your rehab because they make you feel that there is something wrong with your knee and keep you from fully using your leg. Once I got rid of my brace and realized that the repaired knee was working as it should I felt much better. I wasn't aware there was any controversy attached to this.

[Stymie]

thanks all. good discussion.

I'm going to give it a go sans brace... it will be nice to ski without those damn things (plus the hassle of packing them and lugging them to the mountain everytime).

[jfost]

It really does't matter who pays for it. The medical literature doens't support it's use. People hold their braces as close to them as others hold their intrepretation of the Holy Bible, so this conversation is likely to cause much consternation.

here's some consternation:

Medical literature is fraught with cadaveric and questionaire-based "studies". That said, it is all we've got to go on.

The question for you is; Can a well fitted, well designed brace restrain some anterior translation of the tibia under the femur? I think so, but I can't for the life of me get behind the idea that a brace prevents any rotational movement, which is a big component of ACL tears.

So "studies" all seem to show that if *you* think it helps, and you can afford it (through insurance or out of pocket) then brace away... but there's no long-term reason to depend on a brace.

Not very many surgeons I know like to say that a dumb metal and velcro piece of junk would be required after their god-like surgical hands have done their duty!!! Haha - little poke there....

disclaimer: I make this kindof stuff for a living, so I'm biased. If it were me, since I can have any kind of brace for free, I would wear it post-op until I felt my strength had regained, after that,probably not. I have only had a MCL tear, and I wore a brace for about 1 week before getting rid of the thing, but that's a bit of a different animal. Anyway, good topic!!!

[/consternation]

[Dexter Rutecki]

The question for you is; Can a well fitted, well designed brace restrain some anterior translation of the tibia under the femur? I think so,

How?9876

[jfost]

http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed

this one showed some reduction in strain, albeit at low load (what they considered 'less than what a knee would experience in an athletic event')

http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed

here's one that shows a reduction in strain under various conditions - probably funded by a bracing company, as it has better than usual results for something like this!!!

There are a million more, and it is important for me to note that NONE show better outcomes, just *some* reduction in strain under certain loads. It is enough for me to say like I did above that I would wear it until I felt that I had regained my strength, then I would probably get rid of it.

I'm quite sure that in my case, as it may well be with many others, I would see an overall INCREASE in leg strength after completion of an ACL rehab program, as I currently do little or no leg-specific strengthening program. This factor alone could lead to the observation that my outcome wouldn't depend on bracing. I would be in effect "stronger" post-op, if that makes any sense...

Anyway, FWIW on all this... I'm certainly not willing to say that bracing is a requirement as it is obvious how many people do well without.

[altagirl]

Yeah, when my surgeon prescribed them for me, he was referencing a study that showed a very small decrease in re-injuries with people wearing braces. He said it was really minimal, but any increase in safety is better than none. I guess the newer studies aren't showing that now, but that's not too surprising.

I don't see that braces really protect your ACL much at all (too small of a movement can tear it) - but I'd think they DO protect effectively from side impacts and hyperextension. I don't know that that's really related to skiing after an ACL reconstruction, but I don't think they are entirely useless. However the biggest thing is probably how they affect you mentally. If you either go crazy and do things you're not ready for because you feel protected or if you stay overly tentative because braces give you the feeling that there is something wrong with your knees, both make the brace a negative thing.

[Buzzworthy]

Simple. No brace will stop an ACL from going. The brace would have to be tightened to the actual bone at each strap to hold the bones from moving. Since most of us seem to have skin and muscle and stuff like that between the bone and the brace, it has extremely minimal chance of saving an ACL from a twist.

Only thing my Defiance is good for is preventing hyperextension and soothing my mindset and mental crutch.

Mine is not allowing me to set my knee proper for a good carve so I need to figure something out. I am prone to hyperextension though, rock, hard place.

[45hill]

It's all mental and I'll take some mental reassurance in my 50k repair job. I skated for three hours the other day, playing pond hockey, and forgot my brace. In the back of my mind I knew I didn't have it and could tell when extending during a full stride and stopping. For now I like wearing mine but I am sure it's not necessary.

Every doctor I have ever gone to said braces are mental and your muscles are stronger than anything on the market.

[TNKen]

Daughter's ortho basically echo's Dr. Mark post ACL reconstruction. She got a good patellar graft that has done well. She sneaked out on some groomers at about 4 months with a brace. Started playing college volleyball last August with a custom brace. She feels more comfortable with the brace, but knows its not much if any protection.

Only thing doc did say was because of the injury and resulting surgery, some of the nerves endings in the knee joint and surrounding area have been lost. He says a simple neoprene "sleve" around the knee area seems to give some patients some more sensation for balance, and does recommend that. If it helps of course.

Lindz is starting to teach in our hill's ski school this year. She will be out on the hill this weekend for the first time this season, so we'll see how it goes.

Ken