Heyworth Charles R, Berube Lauren E, Gossman Emma C, Milewski Matthew D, Bixby Elise C
Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA.
Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
J Pediatr Soc North Am. 2025 May 30;12:100215. doi: 10.1016/j.jposna.2025.100215. eCollection 2025 Aug.
Anterior cruciate ligament (ACL) injuries are increasingly common in pediatric and adolescent athletes, driven by rising participation in high-risk sports. Functional knee bracing (FKB) has been proposed as a strategy to reduce both initial injuries and reinjuries following ACL reconstruction (ACLR). The current review examines biomechanical and clinical evidence related to the use of FKB status post-ACLR, focusing on its potential in preventing ACL re-injury. Biomechanical studies suggest that FKB may reduce abnormal knee movements in controlled conditions, specifically anterior tibial translation. However, results are inconsistent on preventing injury-inducing movements or mechanisms in the knee when assessed as part of dynamic testing. Clinically, the small number of relevant comparative studies analyzing braced versus nonbraced cohorts show heterogeneous results, with mixed conclusions on whether FKB effectively reduces ACL re-tear rates. There are several understudied aspects associated with FKB, leaving surgeons without definitive recommendations regarding key factors, such as the optimal brace type, the impact of graft type, appropriate timing and duration of brace wear, compliance challenges, and the psychological and proprioceptive effects of bracing on patients. Given the conflicting evidence and lack of definitive existing guidelines, the role of FKB for patients returning to high-risk activities after ACLR currently remains uncertain, underscoring the need for higher-quality research to guide clinical practice, particularly for the highest risk sub-populations of pediatric and adolescent athletes.
(1)Functional knee braces have been shown to reduce anterior tibial translation in controlled conditions but show inconsistent effects on rotational forces and valgus stability during dynamic activities.(2)Clinical studies offer conflicting evidence on the effectiveness of functional bracing in reducing ACL re-tear rates, with no consensus on routine use.(3)Patient-specific factors, including graft type, compliance, and baseline knee stability, may influence the effectiveness of functional bracing.(4)Psychological benefits, such as reduced fear of reinjury, may contribute to the value of bracing, though effects on proprioception and muscle strength are mixed.(5)Further research is needed, particularly with dynamic, sport-specific testing, to determine the true efficacy of functional bracing in ACL reconstruction recovery.
由于参与高风险运动的人数增加，前交叉韧带（ACL）损伤在儿童和青少年运动员中越来越常见。功能性膝关节支具（FKB）已被提议作为一种减少ACL重建（ACLR）后初次损伤和再次损伤的策略。本综述研究了与ACLR后使用FKB相关的生物力学和临床证据，重点关注其预防ACL再次损伤的潜力。生物力学研究表明，FKB可能会在受控条件下减少膝关节异常运动，特别是胫骨前移。然而当作为动态测试的一部分进行评估时，在预防膝关节损伤诱导运动或机制方面结果并不一致。临床上，少数分析支具与非支具队列的相关比较研究结果各异，对于FKB是否能有效降低ACL再次撕裂率存在不同结论。与FKB相关的有几个方面研究不足，使得外科医生在关键因素上没有明确的建议，如最佳支具类型、移植物类型的影响、支具佩戴的合适时机和持续时间、依从性挑战以及支具对患者心理和本体感觉的影响。鉴于证据相互矛盾且缺乏明确的现有指南，FKB对ACLR后恢复高风险活动的患者的作用目前仍不确定，这突出了需要高质量研究来指导临床实践，特别是对于儿童和青少年运动员中风险最高的亚群体。
（1）功能性膝关节支具已被证明在受控条件下可减少胫骨前移，但在动态活动中对旋转力和外翻稳定性的影响不一致。（2）临床研究关于功能性支具在降低ACL再次撕裂率有效性方面提供了相互矛盾的证据，对于常规使用没有共识。（3）患者特异性因素，包括移植物类型、依从性和基线膝关节稳定性，可能会影响功能性支具的有效性。（4）心理益处，如减少再次受伤的恐惧，可能有助于支具的价值，尽管对本体感觉和肌肉力量的影响不一。（5）需要进一步研究，特别是进行动态、特定运动测试，以确定功能性支具在ACL重建恢复中的真正疗效。
