Knee brace recommendations for mild ACL instability?

[badmigraine]

I took up skating vert at age 40, five weeks after arthroscopic surgery to remove a meniscal cartilage tear.

It sure was fun while it lasted.

Anyone have a favorite knee brace/support for a "small ACL tear"? I'm super-sizing my leg muscles right now, but I'd also like to get some extra support for boarding and skiing.

Ta.

[splat]

Do a search for prolotherapy on google.
Or see thread "How to Build a Sidewall."

[Vinman]

Donjoy makes a good off the shelf brace that should do well for an incomplete tear.

[altagirl]

I use a Donjoy Defiance for skiing. This is after ACL reconstruction over 3 years ago and a partial menisectomy this past spring, where the OS determined my ACL graft is now a little stretched. I've been skiing with it for ~16 days so far and it doesn't bother me at all - I generally don't even notice it's there.

[Telekóptero]

confirmed. the donjoy defiance (is that french for "jail"?), . . yup, it's a quality brace. buy spare parts too. nothing sucks more than not realizing you're about to snap a strap (normal wear and tear on any brace when you're highly active), thus precipitating yet another tear.

ooh! buy it custom and get leopard print! in purple and black no less.

[ScottG]

I have heard from several doctor-skiers that braces don't do much to stabilize the knee. Wife has a torn ACL and doesn't use a brace for that reason.

They can be bad if they give you a false sense of strength. They can be good if they remind you that you have an injury and take it easy.

The prolotherapy is interesting - never heard of it, but am curious.
Any personal experience out there??
Thanks,
ScottG

P.S. I found this blurb about braces while looking at some prolo sites:

The Research Reports:
Dr. George Hewson and associates conducted a four year study on football players at the University of Arizonia in Tucson to determine whether the knee brace prevented injury. The study keyed on linemen, linebackers, and tight ends because they are the most likely players to sustain injury. The researchers conclusions was that there was no significant reduction in the number or type of knee injuries.

Football players at the University of North Carolina at Chapel Hill were studied next. Researchers statistically analyzed all knee injuries that occurred five years before and two years after braces began to be used. There was no change in the total number of medial collateral ligament or anterior cruciate ligament injuries.

Football players at Wake Forest University were studied. This study should have caused the abandonment of bracing football players. It showed an increase in the number of serious knee injuries when athletes braced their knees. There were three times the number of severe grade-three anterior cruciate ligament injuries in those using braces. There was an overall increase in knee injuries of 20 percent. The number of surgical procedures on knees increased by almost 50 percent during the bracing years. The overall injury incidence went up from 6.1 (unbraced) to 7.5 (braced) per 100.

Another study on knee bracing involved looking at seven of the most popular functional knee braces used to control anterior tibial displacement in people with ACL laxity. This study confirmed what researchers had already seen, the brace was a myth. The study's authors (Beck, C. et. al. Instrumented testing of functional knee braces. American Journal of Sports Medicine. 1986; 14:253-256.) noted, "Our data also supports the conclusions of other investigators, that as forces increase, the effectiveness of the functional knee braces in controlling anterior tibial displacement decreases. This was evident even at the forces used in our testing modes which, of necessity, were much lower than forces encountered in actual clinical settings." Some of the braces were showing almost no ACL support at the 40-pound of pressure mark. Imagine how the braces would hold up with a 250 pound linebacker smashing them. Other studies confirmed that even the most state-of-the-art braces did not significantly reduce the laxity in an ACL tear or injury. Athletes also found the braces to be unacceptable for running distances or jogging because of discomfort and migration of the brace distally on the knee. A great percentage of the athletes also noticed that the braces did not help them regain their previous athletic status. The only thing that can bring the athlete back to their previous athletic status is Prolotherapy.

Large NCAA Study
The largest study to date, involved looking at seventy-one schools which were members of Division 1 of the NCAA, to assess whether the use of so-called "preventive braces for the knee" was associated with a decrease in either the severity or the incidence (or both) of injuries to the knee in collegiate football players. In the first year of the study, the athletes wearing the braces were twice as likely to be injured. In the second year of the study, the risk of injury was increased by 50 percent. In addition to these facts, the braced athletes were much more likely to receive surgical procedures.

Klein RG, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6(1):23-33.
Bigos S, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14, AHCPR Publication No. 95-0642, December 1994.
Hauser RA. Punishing the pain. Treating chronic pain with prolotherapy. Rehab Manag. 1999;12(2):26-28, 30.
Leslie M. Injecting relief. Sufferers of common aches and pains say they find relief in a new treatment called prolotherapy. What do they know? WebMD Medical News, October 2, 2000. Availabe at: http://webmd.lycos.com/content/article/1668.50767 Accessed July 31, 2001.
Manchikanti L, Pampati V, Fellows B, et al. The diagnostic validity and therapeutic value of lumbar facet joint nerve blocks with or without adjuvant agents. Curr Rev Pain. 2000;4(5)337-344.
Harkins JD, Mundy GD, Stanley SD, et al. Lack of local anaesthetic efficacy of Sarapin in the abaxial sesamoid block model. J Vet Pharmacol Ther. 1997;20(3)229-232.
Tsatsos G, Mandal R. Prolotherapy in the treatment of foot problems. J Am Podiatr Med Assoc. 2002;92(6):366-368.

[badmigraine]

I'm OK with the proposition that braces don't do much, but the studies cited above seem like a snow job. The more I read them, the less I know. What about studies besides those involving football players? Can a certain type of brace do something for a skier or boarder? What type of braces are we talking about here--the "seven most popular" kinds? Popular among whom? There are many types of braces... I wonder which ones were used in the studies.

What exactly is meant by: "athletes wearing the braces were twice as likely to be injured. In the second year of the study, the risk of injury was increased by 50 percent..."

Twice as likely as what? As themselves, doing exactly the same thing but without a brace? That's impossible to prove. Why were these athletes wearing a brace, but other athletes none? Was there a pre-existing instability or injury that made them wear the brace? Was it a controlled study, or did they just keep tabs on athletes who'd chosen to wear braces for their own reasons, such as previous injury or dangerous playing position or style? Were the non-braced athletes bench warmers with little playing time who faced fewer risks of injury? What kind of injury? Was it a knee injury? If so, was it a giant linebacker crushing the knee? I probably won't see those issues on the ski slopes.

As for prolotherapy, I did Google it. It sounds interesting, and I hope it works. It seems credible. But beyond anecdotes and some studies of back pain, it looks like it hasn't yet been proved successful, certainly not for fixing knee ligament tears. Medicare, Aetna and Quackwatch.com all cite the lack of controlled study evidence of its efficacy.

The Prolotherapy home page boasts success on about fifty or seventy diverse complaints ranging from back pain to knee ligament tears to migaine headaches. It sure would be great if this all turns out to be true, but at this point it comes across to the layman like a lot of other unproven fad or miracle cures.

Thanks for posting on this stuff. I'm going to keep poking around on the prolotherapy front, and will probably wear some sort of brace on the slopes, even if just to keep my knee warm and cozy.

[Vinman]

I don't have a study to quote to you but, some research shows that a simple knee sleeve is just as effective as and ACL brace. The reason behind this is one of proprioception. Proprioception is the ability to sense the position you body and limbs are in. The ACL had nerve receptors in it that helps the body sense position. When injured these receptors are damaged as well. The noeprene knee sleeve assists this joint position sense by gving stimulation to similar receptors in the skin. This helps the body "know" what position the knee is in and causes the muscles around the knee to fire to control motion and maintain stability.

The only limiting factor here is I'm not sure if this is true for partial ACL injuries. Most of these studies have been done with ACL deficient or reconstructed ACLs. Might be worth looking into though.

[altagirl]

The more I've read on knee braces the more I've found that there's a study that supports every opinion out there.

I skied with no brace for the first 2 seasons after my ACL reconstruction (OS guidance) and wound up having a stretched graft, meniscus tear and another knee surgery and now my new OS prescribed a brace and said he didn't want me skiing without it - ever. Just like you said with the study, it's impossible to know if wearing a brace would have helped after the first surgery. But now - since the brace is so comfortable, I see it as one of those things that won't hurt and might help - and there's no reason not to wear it.

[ScottG]

Here's an interesting link to a sports medicine study where sensors were implanted in ACL's during surgery, and then used to measure stress with and w/o a brace.

http://www.jointhealing.com/pages/pr..._research.html

Of course they are trying to sell braces.
Here is a link to an abstract of the study:
http://journal.ajsm.org/cgi/content/abstract/28/6/815
and a follow up study:
http://journal.ajsm.org/cgi/content/abstract/31/1/99

Interesting stuff. Thanks for making me challenge what I had been told. I would have thought that an exterior clamp onto the muscle wouldn't do much, since the muscle moves around so much, and the amount of motion required to tear an ACL is not as great.
Do an internet search on "ACL ski injury" and you will find tons of sites. Add the word "brace" to the search to limit it.

[badmigraine]

Thanks, ScottG! I owe you a beer.

And you others too.

Thanks to your posts and motivated Googling, I know a lot more about this stuff and what I can do.

Vinman, you reminded me of the Peanuts strip where Linus tells Charlie Brown "I'm aware of my tongue..." and then CB starts to think about his own floppy wet tongue sitting there inside his mouth...

That's exactly what my neoprene sleeve does, I just never thought about it. It makes me aware of what my knee is doing and my muscles work harder to protect it.

Altagirl, hang in there. I'm short most of a meniscus myself. I'm sure that by the time we really, really, really start to care a lot about this, They will have something new for us that we are going to love.

Cheers!

[altagirl]

I hear ya. I also take glucosamine/chondriotin/SAM-e - anything that's rumored to help - hopefully they'll come up with some better breakthroughs in the future.

It's been feeling pretty good so far this season though. A few twinges after hard days but that's really it. Bonus is that last year before the partial menisectomy I demoed tele gear and it hurt to really drop a knee on one side. This year everything felt great. Woohoo! (Oh, and the brace felt fine during my tele-gaping experience too.)