Embracing the Brace

ACL therapy can get started a few days after surgery to jumpstart healing

(RxWiki News) Knees are only meant to bend forward and backward. If a knee pops and locks up with major pain, something serious is going on there, and it's most likely an ACL injury.

In healing the ACL, therapies that focus on range-of-motion, strength and getting back to normal function are beneficial in the process, a new study has found.

Researchers found that using a brace, which guides the part of the body to bend and move as it's meant to, does not help.

"Knee surgery is tricky - talk to your doctor."

The anterior cruciate ligament is a tendon that crosses behind the inside of the kneecap and helps stabilize the knee as it bends and straightens.

Tears to the ACL, which cause swelling and pain in the knee, can happen by changing direction or stopping quickly or through impact.

Researchers led by Lisa Kruse, MD, a resident in the department of orthopedic surgery at the Washington University School of Medicine in St. Louis, Missouri, looked at 29 studies comparing treatment after reconstructive ACL surgery.

The team included studies that were published between January 2006 and December 2010, excluding non-English studies, those that weren't relevant to what they were looking for, reviews and abstracts from conferences and meetings.

They looked at the level of evidence, number of patients, method of ACL surgery, differences between groups, the interventions and findings of each study.

The injuries often need surgery to reconstruct the ligament, followed by therapy to help rehabilitate the knee.

It does not lower pain, protect from reinjuring the knee or improve the stability of the knee. Rather, braces add an unnecessary expense to the recovery.

Vitamins and other supplements also don't help in the healing process.

Beginning physical therapy shortly after surgery, ideally within a few days after, can bring great outcomes for patients.

Regarding different therapies, researchers found that:

  • Therapies that focus on patients' awareness of how they move may have benefits
  • Neuromuscular therapies are recommended to be used with other therapies, not by itself, and it would not help patients return to athletic activities faster
  • Accelerated rehab and balance therapies may not be harmful
  • Vibration therapy, which strengthens muscle, may lead to more complete recovery and help speed up the recovery process
  • Future research should look further into all the therapies

"The most important thing for ACL surgery patients is to start physical therapy early and rigorously," said Rick Wright, MD, professor and co-chief of the sports medicine department at the Washington University in St. Louis, Mo, in a press release.

"It can be difficult at first, but it's worth it in terms of returning to sports and other activities."

The study was published October 3 in the Journal of Bone and Joint Surgery. No conflicts of interest were reported.

Review Date: 
October 16, 2012