Do I Need a Brace After ACL Surgery?

Bracing after ACL surgery has been recommended for many reasons. But there is no evidence to support routine bracing after ACL surgery.  Some propose that it improves proprioception.  Some believe that a brace is protective.  The most ardent supporters for bracing after ACL surgery are the brace manufacturers and physicians who sell the braces in their office.  Does bracing have an evidence based role in your recovery from ACL surgery? Could bracing actually be harmful to your recovery after ACL surgery?

Most athletes chose to proceed with ACL surgery to stabilize their knee and hopefully allow them to return to sports.  After surgery it is not uncommon to see a huge bandage, covered by a big hinged knee brace.

Does Bracing Protect Your New ACL After Surgery?

During ACL surgery we place a graft (your new ACL) into two bone tunnels.  That graft is secured in place with two screws or other forms of fixation.  That fixation is not tenuous.  That means that the point where we fix your new ligament to the bone is not weak.  It can handle the force put on it during properly supervised rehabilitation.   So, scratch that one out as a reason to brace your knee.

Proponents of bracing after ACL surgery talk about the weakness in the quadriceps and pain as a reason for bracing.  The best way to minimize weakness in the quadriceps is to get the leg moving.  Prehab, or therapy before surgery will not only improve your chance of a better functional outcome, your therapist can show you exercises you can start immediately to minimize the atrophy and weakness that occurs after surgery.  Elevation, ice, multi-modal pain management an help ease the pain.  Some athletes have very little pain, while others have much more pain after ACL surgery.  Most athletes are off of opiod pain medications within a week after surgery.  Does bracing improve pain scores? No.  Elevation, and controlling swelling, and stiffness will ease your pain.  The brace does not play a large role in pain management.

Your quadriceps will be weak after surgery.  No doubt.  You will not be able to walk normally after surgery because of pain and weakness.  It is important that you use crutches for controlled weight bearing.  That means that you put weight on your leg but use the crutches for support so that you are not full weight bearing until your pain and strength allow you to.  As your pain and strength improves, and your gait mechanics normalize you can walk without crutches.  That can take 10 days to 3 weeks depending on the athlete. Don’t rush it… remember this is a marathon recovery, not a sprint.  Perhaps a brace will help you because your knee is locked straight.  But.. the potential downsides of a brace still outweigh this potential benefit.

Are There Risks of Bracing After ACL Surgery?

For decades surgeons and therapists alike focused on the physical aspects of the recovery process after ACL surgery.  We assessed your motion, strength, and agility.  We ignored the psychological component of the recovery process. Many health care professionals now understand how important it is to focus equally on the psychological portion of the recovery process.  There are still far too many athletes who are emotionally scarred from their ACL injury and surgery and will take years to be able to even attempt to return to sports.  What role, if any did bracing play in this??

Well… if you wake up from a procedure with a dressing from your thigh to you shin and that’s covered with a brace from your hip to your ankle I’m guessing that you think you just had a very “big” procedure, and the brace gives the impression that your knee is at risk or fragile.  Why else would you be bundled up like that?

What if you woke up with a large band-aid on the front of your knee and were given crutches to walk with when you left the hospital?  Most of you would not feel that your knee is very fragile.

Bracing and large bandages set the bar from an emotional and psychological perspective for your recovery from the moment you wake up in the recovery room after ACL surgery.  This might not be a big deal for some athletes, but it is a hard thing to overcome for many.  An athlete needs to have confidence that their knee is strong and stable and ultimately will be capable of returning them to the ball field.  Starting them off with a large dressing, and brace doesn’t help give them that impression.  Some athletes will carry that lack of confidence which began on the day of surgery throughout the entire recovery process.

So … there is very little if any proof that routine bracing has a role after ACL surgery.   Many research papers have shown this over the years. In my opinion the potential downsides clearly outweigh any remote potential benefit.

BTW… these are my thoughts, and not medical advice.  If your doc gave you a brace… use it and ask them when you can remove it.