Knee Brace Recommendation for Grade 1-2 LCL Injury
For a grade 1 or 2 LCL injury, use a functional knee brace with a hinged design (either hinge-post-shell or hinge-post-strap), selecting the longest length that comfortably fits the patient's leg, combined with a structured rehabilitation program focused on strength training and flexibility. 1
Optimal Brace Design
A functional knee brace with unilateral or bilateral hinged bars provides the necessary support for mild to moderate LCL instability. 1 The two main design options are:
- Hinge-post-shell design: Uses molded plastic and foam enclosures around the thigh and calf, providing improved tibial-displacement control, greater rigidity, enhanced durability, and better soft tissue contact 2
- Hinge-post-strap design: Uses a strap system around the thigh and calf, which may be more adjustable during rehabilitation when limb girth changes 2
Critical Fitting Requirements
Select the longest brace length that the patient can comfortably wear, as shorter braces provide inadequate LCL protection. 1 Key fitting considerations include:
- Measure thigh circumference 6 inches above the mid-patella to determine proper size 2
- Position hinges precisely relative to the femoral condyles—this is essential for optimal brace performance 1
- Set 10-20 degrees of extension limitation to minimize hyperextension 2
- Regularly tighten straps, tape, or hook-and-pile fasteners to prevent brace migration 1
- Consider shaving leg hair to improve brace-skin contact and limit slippage 2
Custom vs. Off-the-Shelf Selection
Off-the-shelf (presized) braces are generally sufficient for most grade 1-2 LCL injuries and should be prioritized when cost or rapid availability matters. 1 Studies comparing prefabricated and custom braces found few significant clinical differences 2. Reserve custom braces for:
- Abnormal limb contours
- High-level athletes requiring enhanced comfort
- Patients who fail with presized options 2
Essential Treatment Context
Bracing alone is insufficient—strength training, conditioning, technique refinement, and flexibility exercises are more important than the brace itself in LCL injury management. 1 The brace serves as an adjunct to muscular rehabilitation, not a replacement 2.
Important Performance Limitations
- Brace effectiveness diminishes at physiologic stress levels—subjective improvements consistently exceed objective measurements of stability 2, 1
- Energy expenditure may increase during prolonged athletic activities, potentially causing regional muscle ischemia and lactic acid buildup 2
- Braces may create a false sense of confidence, potentially exposing athletes to additional risk 2
Maintenance and Monitoring
Assess brace positioning and structural integrity regularly; replace any broken or damaged brace immediately to ensure maximum functionality. 1 Daily checks by trainers or patients are necessary for optimal performance 2.