Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace

Matthias Jacobi, Nikolaus Reischl, Karolin Rönn, Robert A Magnusson, Emanuel Gautier, Roland P Jakob, Matthias Jacobi, Nikolaus Reischl, Karolin Rönn, Robert A Magnusson, Emanuel Gautier, Roland P Jakob

Abstract

Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Photograph of the ACL-Jack brace.
Figure 2
Figure 2
Diagram showing that the brace consists of an upper thigh (1) and a leg part (2) connected through a hinge at the ankle (3) and knee (4). The load is applied through a relocatable load arm (5) from the hinge to the leg part, which rotates around the distal hinge (3). F = force.
Figure 3
Figure 3
Bars comparing the initial (0) and follow-up (24-month) anterior drawer (bilateral comparison) measured with the Rolimeter of the three treatment groups. Significance is reported in Table 3.
Figure 4
Figure 4
Initial and follow-up MRI six months after treatment with the ACL-Jack brace.

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