Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-02-2018 | Knee

Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain

Authors: Sebastian Tomescu, Ryan Bakker, David Wasserstein, Mayank Kalra, Micah Nicholls, Cari Whyne, Naveen Chandrashekar

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2018

Abstract

Purpose

The effectiveness of ACL functional knee braces to reduce meniscal and ACL strain after ACL injury or reconstruction is not well understood. A new dynamic knee tensioning brace system has been designed to apply an active stabilizing force to the knee. The ability of this system to reduce tissue strains is unknown. The purpose of this study was to test the ability of the dynamically tensioned brace to reduce strain in both the ACL and meniscus during rehabilitation activities.

Methods

A combined in vivo/in silico/in vitro method was used to study three activities: gait, double leg squat, and single leg squat. Muscle forces and kinematics for each activity were derived through in vivo motion capture and applied to seven cadaveric knee specimens fitted with custom braces. Medial meniscal strain and ACL strain were measured in ACL intact, deficient and reconstructed conditions.

Results

The brace lowered peak and average meniscal strain in ACL deficient knees (P < 0.05) by an average of 1.7%. The brace was also found to lower meniscal strain in reconstructed knees (1.1%) and lower ACL strain in ACL intact (1.3%) and reconstructed knees (1.4%) (P < 0.05).

Conclusions

This study supports the use of a brace equipped with a dynamic tensioning system to lower meniscal strain in ACL-deficient knees. Its use may help decrease the risk of subsequent meniscal tears in chronic ACL deficiency or delayed reconstruction. In ACL-intact and reconstructed knees, the brace may be beneficial in injury prophylaxis or in protecting the ACL graft following reconstruction. These results will aid clinicians make informed recommendations for functional brace use in patients with unstable knees.

Level of evidence

II.

Available only for authorised users

Allen AA, Caldwell GL, Fu FH (1995) Anatomy and biomechanics of the meniscus. Oper Tech Orthop 5:2–9CrossRef

Allen C, Wong E, Livesay G, Sakane M, Fu F, Woo S (2000) Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res 18:109–115CrossRefPubMed

Anderson K, Wojtys EM, Loubert PV, Miller RE (1992) A biomechanical evaluation of taping and bracing in reducing knee joint translation and rotation. Am J Sports Med 20:416–421CrossRefPubMed

Andriacchi TP, Dyrby CO (2005) Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech 38:293–298CrossRefPubMed

Bakker R, Tomescu S, Brenneman E, Hangalur G, Laing A, Chandrashekar N (2016) Effect of sagittal plane mechanics on ACL strain during jump landing. J Orthop Res 34:1636–1644CrossRefPubMed

Beynnon BD, Fleming BC (1998) Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomech 31:519–525CrossRefPubMed

Beynnon BD, Fleming BC, Churchill DL, Brown D (2003) The effect of anterior cruciate ligament deficiency and functional bracing on translation of the tibia relative to the femur during nonweightbearing and weightbearing. Am J Sports Med 31:99–105CrossRefPubMed

Beynnon BD, Johnson RJ, Fleming BC, Peura GD, Renstrom PA, Nichols CE, Pope MH (2000) The effect of functional knee bracing on the anterior cruciate ligament in the weightbearing and nonweightbearing knee. Am J Sports Med 25:353–359CrossRef

Cassidy K, Hangalur G, Sabharwal P, Chandrashekar N (2013) Combined in vivo/in vitro method to study anteriomedial bundle strain in the anterior cruciate ligament using a dynamic knee simulator. J Biomech Eng 135:35001CrossRefPubMed

10.

Chew KTL, Lew HL, Date E, Fredericson M (2007) Current evidence and clinical applications of therapeutic knee braces. Am J Phys Med Rehabil 86:678–686CrossRefPubMed

11.

Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG (2007) OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng 54:1940–1950CrossRefPubMed

12.

Delp SL, Ringwelski DA, Carroll NC (1994) Transfer of the rectus femoris: effects of transfer site on moment arms about the knee and hip. J Biomech 27:1201–1211CrossRefPubMed

13.

Dessery Y, Belzile ÉL, Turmel S, Corbeil P (2014) Comparison of three knee braces in the treatment of medial knee osteoarthritis. Knee 21:1107–1114CrossRefPubMed

14.

Erickson A, Yasuda K, Beynnon B, Johnson R, Pope M (1993) An in vitro dynamic evaluation of prophylactic knee braces during lateral impact loading. Am J Sports Med 21:26–35CrossRefPubMed

15.

Fleming BC, Renstrom PA, Beynnon BD, Engstrom B, Peura GD, Johnson RJ, Peura GD, Nichols CE, Pope MH (2000) The influence of functional knee bracing on the anterior cruciate ligament strain biomechanics in weightbearing and nonweightbearing knees. Am J Sports Med 28:815–824CrossRefPubMed

16.

Hall M, Bryant AL, Wrigley TV, Pratt C, Crossley KM, Whitehead TS, Morris HG, Clark RA, Perraton LG (2016) Does meniscal pathology alter gait knee biomechanics and strength post-ACL reconstruction? Knee Surg Sport Traumatol Arthrosc 24:1501–1509CrossRef

17.

Hangalur G, Brenneman E, Nicholls M, Bakker R, Laing A, Chandrashekar N (2016) Can a knee brace reduce the strain in the anterior cruciate ligament? A study using combined in vivo/in vitro method. Prosthet Orthot Int 40:394–399CrossRefPubMed

18.

Hauch KN, Villegas DF, Haut Donahue TL (2010) Geometry, time-dependent and failure properties of human meniscal attachments. J Biomech 43:463–468CrossRefPubMed

19.

Heis F, Paulos L (2002) Tensioning of the anterior cruciate ligament graft. Orthop Clin North Am 33:697–700CrossRefPubMed

20.

Hicks JL, Uchida TK, Seth A, Rajagopal A, Delp S (2015) Is my model good enough? Best practices for verification and validation of musculoskeletal models and simulations of human movement. J Biomech Eng 137:20905CrossRef

21.

Hollis JM, Niciforos Pearsall a. W PG (2000) Change in meniscal strain with anterior cruciate ligament injury and after reconstruction. Am J Sports Med 28:700–704CrossRefPubMed

22.

Jonsson H, Kärrholm J (1990) Brace effects on the unstable knee in 21 cases. A roentgen stereophotogrammetric comparison of three designs. Acta Orthop Scand 61:313–318CrossRefPubMed

23.

LaPrade RF, Smith SD, Wilson KJ, Wijdicks CA (2015) Quantification of functional brace forces for posterior cruciate ligament injuries on the knee joint: an in vivo investigation. Knee Surg Sport Traumatol Arthrosc 23:3070–3076CrossRef

24.

LaPrade RF, Wozniczka JK, Stellmaker MP, Wijdicks CA (2010) Analysis of the static function of the popliteus tendon and evaluation of an anatomic reconstruction: the “fifth ligament” of the knee. Am J Sports Med 38:543–549CrossRefPubMed

25.

Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J, Kang RW, Cole BJ (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34:1334–1344CrossRefPubMed

26.

Levy I, Torzilli P, Warren RF (1982) The effect of medial meniscectomy on anterior–posterior motion of the knee. J Bone Jt Surg 64:883–888CrossRef

27.

Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior–posterior motion of the knee. J Bone Jt Surg Am 64:883–888CrossRef

28.

Liu MQ, Anderson FC, Schwartz MH, Delp SL (2008) Muscle contributions to support and progression over a range of walking speeds. J Biomech 41:3243–3252CrossRefPubMedPubMedCentral

29.

Marans HJ, Jackson RW, Piccinin J, Silver RL, Kennedy DK (1991) Functional testing of braces for anterior cruciate ligament-deficient knees. Can J Surg 34:167–172PubMed

30.

Mishra DK, Daniel DM, Stone ML (1989) The use of functional knee braces in the control of pathologic anterior knee laxity. Clin Orthop Relat Res 241:213–220

31.

Mitsou A, Vallianatos P (1988) Meniscal injuries associated with rupture of the anterior cruciate ligament: a retrospective study. Injury 19:429–431CrossRefPubMed

32.

Oberg T, Karsznia A, Oberg K (1993) Basic gait parameters: reference data for normal subjects, 10–79 years of age. J Rehabil Res Dev 30:210–223PubMed

33.

Oberg T, Karsznia A, Oberg K (1994) Joint angle parameters in gait: reference data for normal subjects, 10–79 years of age. J Rehabil Res Dev 31:199–213PubMed

34.

Pietrosimone BG, Grindstaff TL, Linens SW, Uczekaj E, Hertel J (2008) A systematic review of prophylactic braces in the prevention of knee ligament injuries in collegiate football players. J Athl Train 43:409–415CrossRefPubMedPubMedCentral

35.

Sitler M, Ryan J, Hopkinson W, Wheeler J, Santomier J, Kolb R, Polley D (1989) The efficacy of a prophylactic knee brace to reduce knee injuries in football. A prospective, randomized study at West Point. Am J Sports Med 18:310–315CrossRef

36.

Spindler KP, Wright RW (2008) Clinical practice. Anterior cruciate ligament tear. N Engl J Med 359:2135–2142CrossRefPubMedPubMedCentral

37.

Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AA (2016) Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity. Am J Sports Med 44:400–408CrossRefPubMed

38.

Sterett WI (2006) Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction: a prospective cohort study. Am J Sports Med 34:1581–1585CrossRefPubMed

39.

Taylor KA, Cutcliffe HC, Queen RM, Utturkar GM, Spritzer CE, Garrett WE, DeFrate LE (2013) In vivo measurement of ACL length and relative strain during walking. J Biomech Elsevier 46:478–483CrossRef

40.

Taylor KA, Terry ME, Utturkar GM, Spritzer CE, Queen RM, Irribarra LA, Garrett WE, DeFrate LE (2011) Measurement of in vivo anterior cruciate ligament strain during dynamic jump landing. J Biomech 44:365–371CrossRefPubMed

41.

Wojtys EM, Loubert PV, Samson SY, Viviano DM (1990) Use of a knee-brace for control of tibial translation and rotation. A comparison, in cadavera, of available models. J Bone Jt Surg Am 72:1323–1329CrossRef

42.

Wright RW, Fetzer GB (2007) Bracing after ACL reconstruction: a systematic review. Clin Orthop Relat Res 455:162–168CrossRefPubMed

Title: Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain
Authors: Sebastian Tomescu
Ryan Bakker
David Wasserstein
Mayank Kalra
Micah Nicholls
Cari Whyne
Naveen Chandrashekar
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4794-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 2/2018

Post-operative 3D CT feedback improves accuracy and precision in the learning curve of anatomic ACL femoral tunnel placement

Changes in gait pattern and early functional results after ACL repair are comparable to those of ACL reconstruction

Compensation after treatment for anterior cruciate ligament injuries: a review of compensation claims in Norway from 2005 to 2015

The importance of Blumensaat’s line morphology for accurate femoral ACL footprint evaluation using the quadrant method

There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study

Side-to-side asymmetries in landing mechanics from a drop vertical jump test are not related to asymmetries in knee joint laxity following anterior cruciate ligament reconstruction