DUBLIN — Using a hinged brace after treating medial collateral ligament injuries had no effect in returning function in range of motion, according to a presenter here.
“Medical collateral ligaent injuries cause significant functional impairment,” L.A.K. Khan, said at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011. “We showed no difference in outcome of using a hinged brace or not using a hinged brace.”
Khan and his team compared functional outcome, strength and range of motion in 53 men and 33 women after treatment of medial collateral ligament injuries by either early unprotected mobilization or mobilization with a hinged brace, according to the study abstract.
Fourty-four patients recovered using early unprotected mobilization of the injury, while 42 patients used a hinged brace. Sports were the primary cause of injury in 65% of patients. Skiiing and snowboarding were the most common sports associated with the injuries, according to the study, followed by rugby and football. Return to running, work and full sports were all factors used to assess function, with follow-up at 2 weeks, 6 weeks, 12 weeks and 24 weeks.
Khan said that the results showed no significant difference in range of movement or pain scores between either group. The mean time to return to full weight bearing was 3 weeks in both groups. Patients returned to work at a mean of 4.6 weeks in the braced group and 4.1 weeks in the non-braced group. The braced group took 14.3 weeks to return to running, while the non-braced group returne in 12.8 weeks. Return to full sport was 22 weeks in the braced group and 22.1 weeks in the non-braced group, the authors wrote.
For more information:
Khan LAK, Will E, Keating JF. Does the use of a hinged knee brace influence recovery after a medial collateral ligament injury? A randomised control trial. Paper #248. Presented at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011. Sept. 13-19. Dublin.
The conservative treatment for grades I and II MCL tears is widely advocated due to its intrinsic capacity for healing. For many years, the treatment of choice for those injuries has consisted in the use of a hinged brace, which avoids accidentally valgus stress — which can be painful and allows for a free flexion/extension movement.
These arguments, on the other hand, have recently been contested. Khan and colleagues presented a randomized control trial study where they’ve found no difference in functional outcome, strength and range of motion when using or not using a hinged brace after a MCL injury.
Despite of the interesting findings of this study that supports the early unprotected mobilization of the knee, the psychological aspect of the MCL injured patient should also be taken into account. Many patients under this condition present more confidence in the rehabilitation program using the brace and it is not rare to have patients asking for some protection in their first visit. Moreover, braces can also serve as a “warning” to the public that the patient has sustained an injury, preventing further accidental injury.
— Paulo H. Araujo, MD
University of Pittsburgh