Brace yourself...

Rosemont, Ill. – Wearing a knee brace following anterior cruciate ligament (ACL) surgery has no effect on a person's recovery. However, strength, range-of- motion, and functionality exercises provide significant benefits, and other new therapies may show promise.

In a new literature review recently published in the Journal of Bone and Joint Surgery (JBJS), a team of orthopaedic surgeons reviewed 29 studies regarding treatment following reconstructive ACL surgery. They found that physical therapy, begun shortly after surgery, can bring about very good outcomes for patients. Bracing, though, did not seem to improve results.

The ACL runs through the middle of the knee joint and helps to stabilize it. While the ACL can be injured through impact, it is most commonly strained or torn during non-contact injuries when a person:

• Suddenly changes direction
• Stops abruptly
• Lands incorrectly after a jump

These injuries often require reconstructive surgery, with post-surgical rehabilitative therapy. These therapies usually focus on improving the patient's strength, range of motion, and function, and also may include some balance exercises.

Other findings include:

• Physical therapy should begin early, ideally within a few days after surgery.
• Therapies focusing on proprioception (awareness of movement of one's body) may have benefits; however, the extent of their efficacy requires further research.
• Balance therapies also may be promising.
• Neuromuscular therapies are not harmful, but their benefits are in doubt and require more study. Neuromuscular therapies should be used to support other physical therapies, not in place of them.
• Accelerated rehabilitation also does not appear to be harmful, but should be studied further.
• No vitamins or other supplements have been proven to have any effect on ACL healing.

"The most important thing for ACL surgery patients is to start physical therapy early and rigorously," says Rick W. Wright, MD, professor and co-chief of the sports medicine department at the Washington University Department of Orthopaedic Surgery, St, Louis, Mo. "It can be difficult at first, but it's worth it in terms of returning to sports and other activities."

More information on ACL injuries can be found at orthoinfo.org or in the Sports Medicine Media Guide, available in the media resources section of newsroom.aaos.org.

About JBJS
October 3, 2010 Full JBJS Table of Contents

Early Initiation of Bisphosphonate Does Not Affect Healing and Outcomes of Volar Plate Fixation of Osteoporotic Distal Radius Fractures

Anterior Cruciate Ligament Reconstruction Rehabilitation: A Systematic Review

Long-term results after distal rectus femoris transfer as a part of multilevel surgery for the correction of stiff knee gait in spastic diplegic

Optimization of leukocyte concentration in platelet-rich plasma (PRP) for the treatment of tendinopathy

Does subacromial injection of a local anesthetic influence strength in healthy shoulders? - A double blinded, placebo-controlled study

Comparison of ten year survivorship of hip prostheses with use of conventional polyethylene, metal-on-metal, or ceramic-on-ceramic bearings

Treatment rationale for Dens fractures: Non-rigid immobilization, anterior screw fixation and dorsal transarticular C1/2 fixation rhBMP-2/Calcium Phosphate Matrix Induces Bone Formation While Limiting Transient Bone Resorption in a Nonhuman Primate Core Defect Model

Peri-prosthetic Fractures after Primary Total Shoulder Arthroplasty and Primary Humeral Head Replacement: A 33-year study

Prognostic Factors for Predicting Outcomes after Intramedullary Nailing of the Tibi Landmarks for Rotational Alignment of the Humeral Component During Elbow Arthroplasty

Outcome after sequential hip fracture in the elderly

More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. When orthopaedic surgeons restore mobility and reduce pain, they help people get back to work and to independent, productive lives. Orthopaedic surgeons provide the best value in American medicine in both human and economic terms and access to high-quality orthopaedic care keeps this "Nation in Motion." To learn more, to read hundreds of patient stories or to submit your own story, visit anationinmotion.org.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.