PROPHYLACTIC KNEE BRACING

One moderate quality (Sitler 1990) and one low quality study (Deppen 1994) informed this recommendation.

The Sitler (1990) study discussed the rate of knee ligament injuries in 1,396 braced versus unbraced intramural football players at West Point Military Academy over two fall seasons.  Injuries to the medial collateral ligament was the primary outcome of interest in this study, but ACL injuries were tracked as a secondary endpoint.  A greater number of ACL injuries occurred in the unbraced (n=12) than in the braced (n=4) group; however, this result was not significantly different (Fisher exact probability =0.81).

The Deppen (1994) study assessed the rate of knee ligament injuries in 524 first string, high school football players across four fall seasons. Again, MCL injury, was the primary outcome of interest, with ACL injury secondarily studied. 2 ACL injuries occurred in braced athletes across 21,640 exposures and 7 ACL injuries occurred in non-braced athletes across 19,484 exposures. This difference was not statistically significant (p>0.05), neither was the rate of non-contact versus contact ACL injury significant between groups (2 braced vs 5 non-braced p>0.05).

Benefits/Harms of Implementation

There is ample evidence that prophylactic knee bracing alters lower extremity biomechanics.  These alterations in biomechanics may predispose to other injuries, and without demonstrated ACL injury prevention benefit, may increase rather than decrease overall injury risk. More importantly, reliance on the uncertain properties of prophylactic bracing could decrease participation in injury prevention exercise programs which have been shown to be protective against ACL and other lower extremity injuries.

Outcome Importance

ACL injury is a major source of musculoskeletal cost and morbidity. Additionally, it is a major source of time lost from sport.  Many athletes and individuals never return to the same level of sport or activity following ACL injury.

Cost Effectiveness/Resource Utilization

The financial cost of prophylactic bracing would be considerable. Bilateral bracing of every athlete engaged in high-risk sport would add significantly to the cost of participation and heighten socio-economic bias. This would need to be weighed against any injury reduction benefit which has not been demonstrated to date.

Acceptability

Prophylactic bracing may potentially be acceptable to athletes participating in higher-risk sports

Feasibility

It is not likely feasible to employ prophylactic braces in every athlete for each competition and practice of high-risk sport for ACL injury.

Future Research

Future research could explore subgroups where bracing may show more significant effects.