What kind of knee brace is recommended for a patient returning to sports?

Knee Brace Selection for Return to Sports

The type of knee brace recommended depends entirely on the underlying knee pathology: functional knee braces with hinge-post-shell design for ACL injuries or instability, patellofemoral braces for anterior knee pain/patellar tracking issues, and prophylactic braces are NOT recommended for routine use in uninjured athletes. 1

For ACL-Deficient or Post-ACL Reconstruction Knees

Functional knee braces are the appropriate choice for athletes with ACL injuries or following ACL reconstruction surgery. 2, 1

Design Selection

• Hinge-post-shell design is superior to hinge-post-strap design, providing improved tibial-displacement control, greater rigidity, enhanced durability, and better soft tissue contact 2, 1
• The hinge-post-shell uses molded plastic and foam enclosures around the thigh and calf, while the strap design uses only straps 2

Sizing Considerations

• Select the longest brace length the athlete can comfortably wear to maximize protection and minimize migration 2, 1
• Presized braces are adequate for most patients and offer better cost-effectiveness, as custom braces provide few additional clinical benefits 2
• Measure thigh circumference 6 inches above mid-patella for presized brace selection 2
• Custom braces are reserved for abnormal limb contours or high-level athletes requiring enhanced comfort 2

Fitting Requirements

• Correct hinge placement relative to femoral condyles is essential for optimal performance 2, 1
• Set 10-20 degrees of extension limitation to minimize knee hyperextension 2
• Cover any exposed metal to prevent brace-induced injuries to other players 2
• Choose more durable materials for contact sports 2

Clinical Indications

• Additional support after ACL surgery 2, 1
• Support for mild to moderate PCL or MCL instability 2, 1
• Control of knee hyperextension 2, 1

Important Limitations and Caveats

• Functional braces may increase energy expenditure and decrease agility during prolonged athletic activity 2, 1
• Regional muscle ischemia and lactic acid buildup can precipitate muscle fatigue 2
• Braces may create a false sense of confidence, potentially exposing athletes to additional risk 2, 1
• Objective protective effects diminish at physiologic stress levels despite subjective improvements 2
• Bracing must be combined with appropriate rehabilitation—strength training, conditioning, technique refinement, and flexibility are more important than bracing alone 2, 1

For Patellofemoral Pain Syndrome

Patellofemoral braces are indicated for anterior knee pain related to patellar tracking disorders. 2

Clinical Indications

• Patellar subluxation and/or dislocation 2
• Patellar translation 2
• Tendonitis 2
• Chondromalacia of the patella 2

Mechanism and Benefits

• Improved patellar tracking during knee flexion and extension 2
• Dissipated lateral forces 2
• Decreased anterior knee pain 2

Important Caveat

• Subjective benefits consistently exceed objective findings with patellofemoral braces 2
• Pain relief with regular brace wear is relatively insignificant 2
• Conservative therapy (simple stretching and strengthening) is more effective than bracing alone 2

Prophylactic Braces for Uninjured Athletes

Prophylactic knee braces are NOT recommended for routine use at any level of athletic competition. 2

Evidence Against Routine Use

• The AAFP concluded that prophylactic knee braces lack sufficient evidence of efficacy in reducing the incidence or severity of ligamentous knee injuries 2
• Prophylactic braces cannot protect the MCL during direct lateral impact 2
• Strength training, conditioning, technique refinement, and flexibility are more important than prophylactic bracing in MCL injury prevention 2
• May limit speed and agility, particularly concerning for skill position players 2
• Can create a false sense of security for previously injured knees 2

Limited Potential Role

• May be considered for athletes at very high risk for MCL injury (e.g., offensive/defensive linemen in football) 2
• Re-injury protection after previous MCL injury 2
• If used, select the longest brace that fits to maximize MCL protection 2

Key Clinical Pitfalls to Avoid

• Do not prescribe prophylactic braces for routine injury prevention in healthy athletes—the evidence does not support this practice 2
• Do not rely on functional braces as the primary treatment for ACL instability—they are adjuncts to comprehensive rehabilitation 2, 1
• Do not assume custom braces are superior—presized braces offer similar clinical outcomes at lower cost 2
• Ensure daily assessment of brace positioning and structural integrity—broken or damaged braces should be replaced immediately 2
• Do not overlook proper fitting—incorrect hinge placement or inadequate length compromises effectiveness 2, 1