Knee Brace Duration After Injury
Postoperative knee braces should not be used routinely after knee injuries as they do not improve outcomes and should be phased out over time if used initially for comfort. 1
Recommendations by Injury Type
ACL Reconstruction
- Postoperative knee bracing is not recommended following ACL reconstruction as it does not improve stability, function, or outcomes at 2-year follow-up 2, 3
- If a brace is used for initial comfort, it should be limited to a maximum of 4-6 weeks 2
- Multiple clinical practice guidelines (CPGs) including those from NZGG, DOA, MOON, and AAOS explicitly recommend against routine use of postoperative knee braces 1
Ankle Ligament Injuries
- For ankle ligament injuries, a brace may be used for 3-6 weeks depending on injury severity 1
- For partial or total ligament ruptures, brace use may extend to 6-8 weeks depending on task requirements and physiotherapy results 1
- It is recommended to phase out the use of ankle braces over time rather than abruptly stopping 1
Shoulder Dislocations
- Functional support is recommended for 4-6 weeks over rigid immobilization for reduced shoulder dislocations 4
- Any rigid immobilization should be limited to a maximum of 10 days to treat pain or edema 4
Evidence on Brace Effectiveness
Benefits of Bracing
- Braces may provide subjective improvements in stability and confidence that exceed objective measurements 1
- For ankle injuries, braces can reduce the risk of recurrent inversion injuries in athletes (RR 0.53,95% CI 0.40 to 0.69) 1
- Workers with lateral ankle injuries who use semi-rigid ankle braces resume work faster than those using elastic bandages (4.2 days sooner; 95% CI 2.4 to 6.1 days) 1
Limitations of Bracing
- Functional knee braces may increase energy expenditure during lengthy athletic activities 1
- Prolonged brace use can lead to regional muscle ischemia and lactic acid build-up, potentially increasing muscle fatigue 1
- Extended immobilization can contribute to stiffness and joint dysfunction 4
Brace Selection and Usage
Functional Knee Braces
- Available in custom or presized models with either "hinge-post-shell" or "hinge-post-strap" designs 1
- Hinge-post-shell designs may provide better tibial-displacement control, greater rigidity, and enhanced durability 1
- Presized braces are appropriate for patients with changing limb girths during rehabilitation 1
Ankle Braces
- Due to practical usability and cost considerations, a brace is generally preferable to tape for ankle injuries 1
- The choice between brace and tape should be based on individual situation and personal preference 1
Common Pitfalls to Avoid
- Prolonged brace use can create a false sense of security and potentially increase injury risk 1
- Extended immobilization does not reduce recurrence rates but may contribute to joint stiffness 4
- Braces should not replace proper rehabilitation including strength training, conditioning, and technique refinement 1
- Failure to phase out brace use can lead to dependency and decreased natural joint stability 1
Rehabilitation Considerations
- Exercise therapy should be incorporated alongside or after brace use to prevent recurrences 1
- For knee injuries, balance between quadriceps and hamstring strengthening is necessary for proper joint kinematics 5
- Rehabilitation should focus on proprioception, strength, coordination, and functional joint stability 1, 6