What type of knee brace is recommended for knee injuries?

Knee Brace Recommendations for Knee Injuries

The type of knee brace recommended depends entirely on the specific injury: prophylactic braces with hinges for MCL protection in high-risk athletes, functional braces for ACL/PCL instability post-injury or post-surgery, patellofemoral braces for patellar subluxation and anterior knee pain, and unloader braces for unicompartmental knee osteoarthritis. 1

Prophylactic Knee Braces

Indications

• MCL protection against valgus knee stresses in high-risk athletes (particularly offensive and defensive linemen in football) 1
• Re-injury protection after previous MCL injury 1

Evidence and Limitations

• The AAFP concluded that prophylactic knee braces lack sufficient evidence of efficacy in reducing the incidence or severity of ligamentous knee injuries 1
• At best, they offer limited resistance to lateral knee impact with little meaningful rotational stress protection 1
• Strength training, conditioning, technique refinement, and flexibility are more important than prophylactic bracing for MCL injury prevention 1
• May cause performance limitations (decreased speed and agility) 1

Fitting Recommendations

• Select the longest brace that fits the athlete's leg, as shorter braces provide less MCL protection 1
• Off-the-shelf models provide similar benefits to custom braces at lower cost 1
• Use unilateral or bilateral hinged bars 1
• Correctly place hinges relative to femoral condyles for optimal performance 1

Clinical Recommendation

Regular use of prophylactic knee braces at any level of athletic competition is not recommended based on current evidence 1

Functional Knee Braces

Indications

• Additional support after ACL surgery for graft protection 1
• Support for mild to moderate PCL or MCL instability 1
• Control of knee hyperextension 1

Contraindications

• Unstable knees requiring operative therapy 1
• Complicated multi-directional knee injuries such as corner injuries 1

Evidence

• Offer some control of external knee rotation and anteroposterior joint translation 1
• Brace wearers consistently report subjectively improved knee stability and function 1
• However, objective effects diminish at physiologic stress levels 1
• Lower extremity muscle strengthening, flexibility improvements, and technique refinement are more important than functional bracing in treating ligamentous knee injuries 1

Fitting Recommendations

• Presized braces are adequate for most patients and are more cost-effective than custom braces 1
• Custom braces are appropriate for abnormal limb contours, high-level athletes, or enhanced comfort 1
• Choose the longest length the athlete can comfortably wear 1
• Set 10 to 20 degrees of extension limitation to minimize hyperextension 1

Patellofemoral Knee Braces

Indications

• Patellar subluxation and/or dislocation 1, 2
• Patellar translation 1
• Anterior knee pain from patellofemoral malalignment 1, 2
• Tendonitis and chondromalacia of the patella 1

Evidence

• Most patients report significant subjective improvements in pain and disability with brace wear 1, 2
• Work by improving patellar tracking through a medially directed force 1, 2
• For acute patellar dislocation, a short period of knee bracing in extension with progression to weightbearing is recommended 3
• Bracing with limited range of motion, stretching, and neuromuscular exercises are the most commonly recommended physiotherapy methodologies 4

Important Caveat

• Subjective benefits exceed objective findings in most studies 1
• The evidence base lacks well-controlled studies 1
• Despite limited objective evidence, patients consistently welcome these braces 1

Fitting Recommendations

• Off-the-shelf versions are adequate for most patients without need for customization 1, 2
• More active individuals may benefit from a brace with lateral hinge and adjustable patellar buttress 1, 2
• Measure leg circumference 3 inches above and below mid-patella according to manufacturer guidelines 1
• Position buttress supports comfortably and align patella in center of cutout 1
• Periodically inspect for migration, strap loosening, or material fatigue 1, 2

Comprehensive Treatment Approach

• Patellofemoral braces should be used in conjunction with a comprehensive knee rehabilitation program that includes strengthening, flexibility, and technique improvements 1
• Consider shoe orthoses in addition to bracing for recalcitrant patellofemoral pain syndrome 1, 2
• Progressive quadriceps strengthening should be included 2
• Patellar taping provides short-term pain relief and functional improvement 2

Unloader Braces for Knee Osteoarthritis

Indications

• Unicompartmental knee osteoarthritis with varus or valgus malalignment 5, 6

Evidence

• Decrease pain, improve function, and improve quality of life 5
• One 2017 study found knee bracing to be more cost-effective than total knee replacement and could potentially replace the need for surgery 5
• Walking distances were significantly longer in the brace group at 3 months, 12 months, and overall 6
• Better effects seen in varus alignment, severe OA, secondary OA, and patients younger than 60 years 6

Limitations

• Many patients do not adhere long-term to this conservative treatment 6
• Minor complications like soft tissue irritation may occur due to poor fitting 5
• Regular follow-up is recommended to address fitting issues 5

Key Clinical Pitfalls to Avoid

• Do not rely on prophylactic braces alone for injury prevention—prioritize strength training and conditioning 1
• Do not use functional braces as a substitute for proper rehabilitation and muscle strengthening 1
• Do not expect objective improvements from patellofemoral braces despite strong subjective benefits 1
• Ensure proper fitting and regular inspection of all braces to prevent migration and maintain effectiveness 1, 2
• Do not prescribe lateral heel wedges for patellofemoral pain as they may worsen symptoms 2