When to Discontinue Knee Brace After ACL Surgery
Knee braces should not be used routinely after ACL reconstruction and can be discontinued immediately or within the first 4 weeks postoperatively, as they do not improve clinical outcomes, function, or stability.
Evidence Against Routine Bracing
The highest quality guidelines consistently recommend against functional bracing after ACL reconstruction:
- The British Journal of Sports Medicine (2020) explicitly states that guidelines recommend AGAINST functional bracing after ACL reconstruction 1
- A 2019 meta-analysis of randomized controlled trials demonstrated that knee bracing does not improve knee function scores, stability evaluations, IKDC scores, Lysholm scores, Tegner scores, side-to-side differences, single-leg hop tests, or pain scores 2
- Multiple systematic reviews conclude there is no scientific evidence to support routine use of functional knee braces following successful ACL reconstruction 3
Typical Bracing Duration (When Used)
When surgeons do choose to use braces despite the evidence:
- Most protocols use braces for 3-6 weeks postoperatively if employed at all 4
- One study used braces for a median of 4 weeks (range 3-6 weeks) and found no difference in outcomes compared to no bracing at 2-year follow-up 4
- Historical protocols from the 1990s recommended brace use for up to 12 months, but this is no longer supported by current evidence 5
Functional Testing for Brace Discontinuation
If a brace is being used and you want objective criteria for discontinuation, patients should demonstrate 6:
- 90% limb symmetry index on four one-legged hop tests (single hop, crossover hop, triple hop, timed hop)
- Knee Outcome Survey Activities of Daily Living Scale score ≥90%
- Global rating of knee function ≥90%
- Burst superimposition strength test passing criteria
Notably, 62 of 64 patients (97%) performed BETTER without their brace than with it at one year post-surgery, suggesting braces may actually impair performance 6
Clinical Implications
The evidence strongly supports immediate discontinuation or non-use of braces:
- A 2-year follow-up study of 78 patients found no difference in KT-1000 measurements, one-leg hop quotients, Lysholm scores, Tegner activity levels, or IKDC classifications between braced and non-braced groups 4
- Functional knee braces offer limited objective benefits, with subjective improvements exceeding objective findings 1
- Braces may create a false sense of confidence and can increase energy expenditure while decreasing agility 1
Rehabilitation Focus Instead of Bracing
Rather than relying on braces, focus on evidence-based rehabilitation 1:
- Immediate knee mobilization within the first week to improve range of motion
- Isometric quadriceps exercises starting in the first 2 postoperative weeks (straight leg raises, static contractions)
- Early weight-bearing as tolerated within the first week
- Progressive closed kinetic chain exercises (leg press starting at 3 weeks)
- Strength and neuromuscular training throughout recovery
Common Pitfalls to Avoid
- Do not continue bracing based on tradition or patient/surgeon preference alone - the evidence does not support benefit 3, 2
- Avoid creating psychological dependence on the brace, which provides a false sense of security 1
- Do not substitute brace use for appropriate rehabilitation and muscle strengthening, which are far more important than bracing 1