Bracing can partially limit tibial rotation during stressful activities after anterior crucial ligament reconstruction with a hamstring graft - 24/05/16

Doi : 10.1016/j.otsr.2016.04.005

D. Giotis ^a, N.K. Paschos ^a,^b,^⁎ , F. Zampeli ^a, E. Pappas ^a,^c,^d, G. Mitsionis ^a, A.D. Georgoulis ^a
^a Orthopaedic sports medicine center, department of orthopaedic surgery, university of Ioannina, Ioannina, Greece
^b Department of biomedical engineering, university of California, One Shields Avenue, Davis, 95616, CA, USA
^c Discipline of physiotherapy, faculty of health sciences, university of Sydney, Sydney, NSW, Australia
^d Department of physical therapy, Long Island university, Brooklyn campus, Brooklyn, New York, USA

^⁎Corresponding author.

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Abstract

Background

Hamstring graft has substantial differences with BPTB graft regarding initial mechanical strength, healing sequence, and vascularization, which may imply that a different approach during rehabilitation period is required. The purpose of this study was to investigate the influence of knee bracing on tibial rotation in ACL-reconstructed patients with a hamstring autograft during high loading activities. The hypothesis was that there would be a decrease in tibial rotation in the ACL-reconstructed braced knee as compared to the unbraced knee.

Methods

Twenty male patients having undergone unilateral ACL reconstruction with a semitendinosus/gracilis autograft were assessed. Kinematic data were collected with an eight-camera optoelectronic system during two stressful tasks: (1) descending from a stair and subsequent pivoting; and (2) landing from a platform and subsequent pivoting. In each patient, three different experimental conditions were evaluated: (A) wearing a prophylactic brace (braced condition); (B) wearing a patellofemoral brace (sleeved condition); (C) without brace (unbraced condition). The intact knee without brace served as a control.

Results

Tibial rotation was significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (P≤0.01 for both tasks). Presence of a brace or sleeve resulted in lower tibial rotation than in the unbraced condition (p=0.003 for descending/pivot and P=0.0004 for landing/pivot). The braced condition resulted in lower rotation than the sleeved condition for descending/pivoting (P=0.031) while no differences were found for landing/pivoting (P=0.230).

Conclusion

Knee bracing limited the excessive tibial rotation during pivoting under high loading activities in ACL-reconstructed knees with a hamstring graft. This partial restoration of normal kinematics may have a potential beneficial effect in patients recovering from ACL reconstruction with a hamstring autograft.