Functional Brace in ACL Surgery: Force Quantification in an In Vivo Study

Robert F LaPrade, Melanie B Venderley, Kimi D Dahl, Grant J Dornan, Travis Lee Turnbull, Robert F LaPrade, Melanie B Venderley, Kimi D Dahl, Grant J Dornan, Travis Lee Turnbull

Abstract

Background: A need exists for a functional anterior cruciate ligament (ACL) brace that dynamically supports the knee joint to match the angle-dependent forces of a native ACL, especially in the early postoperative period.

Purpose/hypothesis: The purpose of this study was to quantify the posteriorly directed external forces applied to the anterior proximal tibia by both a static and a dynamic force ACL brace. The proximal strap forces applied by the static force brace were hypothesized to remain relatively constant regardless of knee flexion angle compared with those of the dynamic force brace.

Study design: Controlled laboratory study.

Methods: Seven healthy adult males (mean age, 27.4 ± 3.4 years; mean height, 1.8 ± 0.1 m; mean body mass, 84.1 ± 11.3 kg) were fitted with both a static and a dynamic force ACL brace. Participants completed 3 functional activities: unloaded extension, sit-to-stand, and stair ascent. Kinematic data were collected using traditional motion-capture techniques while posteriorly directed forces applied to the anterior aspect of both the proximal and distal tibia were simultaneously collected using a customized pressure-mapping technique.

Results: The mean posteriorly directed forces applied to the proximal tibia at 30° of flexion by the dynamic force brace during unloaded extension (80.2 N), sit-to-stand (57.5 N), and stair ascent (56.3 N) activities were significantly larger, regardless of force setting, than those applied by the static force brace (10.1 N, 9.5 N, and 11.9 N, respectively; P < .001).

Conclusion: The dynamic force ACL brace, compared with the static force brace, applied significantly larger posteriorly directed forces to the anterior proximal tibia in extension, where the ACL is known to experience larger in vivo forces. Further studies are required to determine whether the physiological behavior of the brace will reduce anterior knee laxity and improve long-term patient outcomes.

Clinical relevance: ACL braces that dynamically restrain the proximal tibia in a manner similar to physiological ACL function may improve pre- and postoperative treatment.

Keywords: ACL brace; anterior cruciate ligament injury; anterior tibial translation; functional brace; lower extremity biomechanics.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Össur funded this study and provided unrestricted, in-kind donations of the braces utilized in this study. R.F.L. is a consultant for and receives royalties from Össur, Arthrex, and Smith & Nephew.

Figures

Figure 1.
Figure 1.
Mean posteriorly directed force applied by each brace to the (A) proximal and (B) distal tibia during unloaded extension as a function of flexion angle at each force setting.
Figure 2.
Figure 2.
Mean posteriorly directed force applied by each brace to the (A) proximal and (B) distal tibia during sit-to-stand as a function of flexion angle at each force setting.
Figure 3.
Figure 3.
Mean posteriorly directed force applied by each brace to the (A) proximal and (B) distal tibia during stair ascent as a function of flexion angle at each force setting.
Figure 4.
Figure 4.
Mean posteriorly directed proximal force applied by each brace during sit-to-stand at force level 2 compared with previously published mean anterior-posterior in vivo anterior cruciate ligament forces.

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