Hinge Brace Duration After Patellar Tendon Repair
Routine use of a postoperative hinge brace after patellar tendon repair is not recommended, and if used at all, should be discontinued by 4 weeks to avoid complications including quadriceps atrophy, reduced range of motion, and delayed functional recovery.
Evidence Against Prolonged Bracing
The available evidence consistently demonstrates that postoperative knee bracing provides no meaningful benefit after patellar tendon procedures:
Multiple high-quality guidelines recommend against routine functional bracing after ACL reconstruction using patellar tendon grafts, with no differences in stability, function, or outcomes between braced and non-braced patients 1.
Research shows bracing for 12 weeks after patellar tendon ACL reconstruction provided no advantage in knee scores, activity levels, laxity, or muscle strength at 5-year follow-up 2.
Patients treated without braces had equivalent or superior outcomes compared to those braced for 4-6 weeks, with no differences in stability or subjective function at 2-year follow-up 3.
Four-year data confirms no benefit from 6 weeks of bracing after patellar tendon graft procedures, with the non-braced group actually reporting significantly less pain during sports activity 4.
Complications of Prolonged Bracing
Bracing beyond 4 weeks is associated with measurable harm:
Quadriceps muscle atrophy occurs more frequently in braced patients, particularly when motion is restricted 5.
Range of motion is significantly reduced in braced patients at both 4 weeks (90° vs 115°) and 3 months (125° vs 133°) compared to non-braced patients 5.
Functional outcomes are worse in braced patients during the first 6 months of recovery 5.
Re-operation rates may be higher in braced patients, with one study showing 12.1% re-operation rate in braced versus 0% in non-braced groups 6.
Recommended Rehabilitation Approach
Instead of prolonged bracing, focus on early mobilization and progressive strengthening:
Immediate knee mobilization within the first week should be initiated to increase range of motion, reduce pain, and prevent soft tissue complications 1, 7.
Isometric quadriceps exercises should begin in the first postoperative week if pain-free, progressing to concentric and eccentric exercises 1, 7.
Early full weight-bearing as tolerated is encouraged rather than relying on brace support 1.
Closed kinetic chain exercises should be prioritized in the first month to reduce patellofemoral pain risk 1, 7.
Clinical Caveats
If a brace is used for patient comfort or surgeon preference:
Limit duration to maximum 4 weeks to minimize complications 3, 5.
Monitor for quadriceps lag and discontinue brace once straight leg raise without lag is achieved (typically 41-44 days) 6.
Ensure the brace does not restrict motion beyond what is surgically necessary, as motion restriction causes more harm than benefit 5.
Consider that bracing may provide false sense of security without actual protective benefit 1.