Knee Brace Application Does Not Affect Thigh Muscle Strength and Knee Range of Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Abstract

To evaluate the effect of rehabilitative knee bracing on thigh muscle strength, knee mobility, subjective and objective performance, knee stability, and functional test outcomes following anterior cruciate ligament (ACL) reconstruction. In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with INPLASY, we included randomized controlled trials and cohort studies comparing knee bracing versus no bracing after ACL reconstruction. Outcome measures were collected preoperatively and at defined study intervals of each study. Primary outcomes were thigh muscle strength and knee mobility, while secondary outcomes included International Knee Documentation Committee score, Tegner score, Lysholm score, visual analog scale for pain, knee anterior laxity, and the 1-legged hop test. Data were collected from multiple databases and analyzed using Comprehensive Meta-Analysis software, with bias assessed via the Cochrane Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale. Fourteen studies with 1,199 patients were included, with follow-up ranging from 2 weeks to 4 years. Knee bracing showed no significant effect on isokinetic flexion (standardized mean difference [SMD] = -0.027; P = .935; 4 studies) or extension torque (SMD = -0.007; P = .980; 4 studies) within 2 years, flexion range of motion within 3 months (SMD = -0.001; P = .997; 4 studies), or extension deficits within 3 months (SMD = 0.355; P = .334; 3 studies) and 2 years (SMD = -0.439; P = .132; 3 studies). Secondary outcomes also showed no significant group differences. This systematic review and meta-analysis demonstrated that rehabilitative bracing after ACL reconstruction did not result in significant differences in thigh muscle strength or knee range of motion compared to nonbracing protocols. On the other hand, no significant differences were observed between the brace and nonbrace groups in terms of stability and functional outcomes. Level III, systematic review and meta-analysis of Level I-III studies.