What is the best type of knee brace for an Anterior Cruciate Ligament (ACL) tear?

Best Knee Brace for ACL Tear

For ACL tears, a functional knee brace with a hinge-post-shell design is the most appropriate option as it provides better tibial-displacement control, greater rigidity, enhanced durability, and better soft tissue contact compared to other brace types. 1

Types of Knee Braces for ACL Tears

• Functional knee braces are specifically designed to reduce knee instability following ACL injury and to decrease additional injuries during athletic activities 1
• These braces are available in two main designs:
  • Hinge-post-shell design: Uses a molded shell of plastic and foam for thigh and calf enclosures 1
  • Hinge-post-strap design: Uses a system of straps around the thigh and calf 1
• Functional braces are indicated for additional support after ACL surgery and for support of mild to moderate PCL or MCL instability 1

Benefits of Functional Knee Braces for ACL Tears

• Control of knee hyperextension, which is crucial for ACL-deficient knees 1
• Augmented knee proprioception, although evidence suggests this benefit may be limited 1, 2
• Subjective improvements in stability, pain attenuation, and confidence during athletics 1
• May reduce subsequent injury rates while skiing in both ACL-deficient and reconstructed knees 3

Limitations of Functional Knee Braces

• Increased energy expenditure and decreased agility during lengthy athletic endeavors 1
• May create a false sense of confidence during athletics following ACL reconstruction 1
• Effects on translation and rotation diminish at physiologic levels of use 1
• Current bracing technologies do not sufficiently restore normal biomechanics to the ACL-deficient knee 3
• Meta-analyses show bracing does not appear to improve clinical outcomes on function and stability for ACL-reconstructed knees 4

Proper Fitting and Selection

• Select the longest brace that fits the patient's leg, as shorter braces provide less protection 1
• Try several different braces before purchase to determine the best fit 1
• Ensure correct placement of hinges relative to femoral condyles for optimal performance 1
• Regularly tighten straps, tape, or hook-and-pile fasteners to reduce unwanted brace migration 1
• Shave leg hair and fit the brace closely to the contours of the leg to improve brace-skin contact and limit unwanted slippage 1

Custom vs. Off-the-Shelf Braces

• Off-the-shelf braces are generally sufficient for most ACL injuries 5
• Custom braces are more expensive but provide few additional benefits over off-the-shelf models 1
• Presized braces may be better when cost or rapid availability is important 5

Important Clinical Considerations

• Bracing should be combined with appropriate rehabilitation exercises for optimal outcomes 5
• Strength training, conditioning, technique refinement, and flexibility are more important than bracing alone in ACL injury management 1
• Regularly assess brace positioning and structural integrity; replace damaged braces 1
• For combined ACL and MCL tears, appropriate bracing of the MCL component can lead to good outcomes 5
• Bracing alone cannot prevent ACL reinjury and should be considered as one component of a comprehensive rehabilitation approach 6