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 here. “We showed
no difference in outcome of using a hinged brace or not using a hinged
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.
Forty-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. Skiing 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
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
returned 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. — by
Kristine Houck, MA, ELS
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 medical collateral
ligament (MCL) tears is widely advocated due to its intrinsic capacity for
healing. For many years, the treatment of choice for those injuries has
consisted of the use of a hinged brace, which avoids accidental 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 in which 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 the interesting findings of this study that support the early
unprotected mobilization of the knee, the psychological aspect of the MCL
injured patient should also be taken into account. Many patients with 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.
— Freddie H. Fu, MD, DSc(Hon),
University of Pittsburgh Pittsburgh