Connecticut Medicine

Mar 2015

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volume 79, no. 3 167 e Use of Braces in Athletes for Injury Prevention Imran Hafeez, mD Introduction T he use of braces by athletes is very common at all skill levels. from professional athletes to recreation league participants, the use of braces seems to be growing. Braces are a multi-billion dollar industry and the reasons for their use vary widely. It is not uncommon and may be appropriate for individuals to utilize a brace when recovering from an acute or overuse injury. e purpose of this article is to examine the use of braces as a prophylaxis to injury. e most commonly used braces are for the knee and ankle which will be the focus of this article. e use of wrist, elbow and shoulder braces are very common after injury but their use as a prophylactic measure is not well documented. Knee Bracing ere are numerous types of knee braces available for the purposes of symptomatic relief to lessening the effects of injury to the knee. ere are four broad categories for knee braces. ese include knee sleeves, functional knee braces, postoperative, or rehabilitative knee braces, and prophylactic knee braces. 1 Knee sleeves are typically slip-on braces made of a conforming material such a neoprene. Knee sleeves can provide compression, warmth, and may enhance pro- prioception about the knee. 1 functional knee braces are usually made from compos- ite materials with biaxial medial and lateral hinges with a variable stop that can be used to limit hyperextension of the knee. 1 rehabilitative or post-operative knee braces usually have biaxial rigid bars with bilateral adjustable hinges at the knee to control the range of motion. ese braces will often have foam liners surrounding the thigh, knee and calf along with multiple adjustable straps. 1 Prophylactic knee braces are typically comprised of hinges, side bars, and adhesive straps with an intended goal of limiting valgus stress to the knee from trauma to prevent ligamentous injury to the knee, including the medial collateral, anterior cruciate, and posterior cruciate ligaments. 1 ere are clinical studies that have supported the use of prophylactic knee bracing. One of the most widely referenced has been the 1990 study of 1,396 West Point cadet intramural tackle football players. In this study, the rate of injury in the unbraced group was more than double that of the braced group (3.4 vs. 1.5 injuries/1000 exposures), however the only statistically significant find- ings were the reductions in total and mCL knee injuries. 2 In the West Point study, the reduction in injury was found to be dependent on player position. It was noted that those wearing prophylactic knee braces on defense had significantly fewer knee injuries compared to their non-braced controls. is was not found to be true for offensive players where no significant difference in knee injuries was noted between the control group and those wearing the prophylactic knee brace. 2 ere was a similar study of 987 Big Ten varsity foot- ball players. e players were stratified by position and playing condition. is study showed a trend towards decreased mCL injuries with prophylactic bracing at all positions during practice and among linemen, lineback- ers, and tight ends in games. 3 a study from 2005 looking at prophylactic knee braces in contact sports concluded that braces may be effective in reducing the risk of and mCL in football. e same study showed that the use of prophylactic knee bracing for prevention of aCL sprains from external blows to the knee remains a question. 5 a systematic review from 2010 looking at the efficacy of prophylactic knee bracing on preventing mCL injuries in football players found that prophylactic bracing has not consistently reduced mCL injuries in football players. e review went on to say that there is lacking consistent Imran Hafeez, mD, Connecticut Children's medicine Center, farmington and assistant Professor of Orthopaedic Surgery, University of Connecticut School of medicine, Ihafeez@ connecticutchildrens.org.

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