March 13th, 2004
AOSSM Specialty Day

The Role of Functional Bracing in Preventing Injury in ACL Reconstructed Professional Skiers: a prospective cohort study

Authors:
  1. Timothy D. Farley MD, Steadman Hawkins Clinic, Vail, CO
  2. William I. Sterett MD, Steadman Hawkins Clinic, Vail, CO
  3. Karen K. Briggs MPH, MBA, Steadman Hawkins Sports Medicine Foundation, Vail, CO
  4. Chris Dennett ATC, Steadman Hawkins Clinic, Vail, CO
  5. J. Richard Steadman MD, Steadman Hawkins Sports Medicine Foundation, Vail, CO
Objective:  The purpose of this study was to determine the effect of functional bracing on subsequend knee injury in the ACL reconstructed (ACLr) professional skier utilizing a prospective cohort design.
Methods:  A cohort of 818 professional skiers, who were at least 2 years post-ACL reconstruction, was identified from a total of 11606 professional skiers that had undergone preseason screening between 1991 and 1997. Allocation of functional bracing during skiing was by a process of shared doctor-patient decision-making. The dependent variable was subsequent knee injury, identified by worker’s compensation records. In this cohort, 260 braced skiers were compared to 567 non braced skiers.
Results:   In this study, 260 braced skiers were identified and compared to 567 non braced skiers. At pre-season screening, braced skiers had significantly higher preseason rates of grade II or higher Lachman and pivot shifts (29 and 22 % versus 11 and 10 %,respectively)(p<0.05). A total of 61 subsequent knee injuries were identified, 51 (8.9 %) in the nonbraced group and 10 (4.0 %) in the braced group(p=0.009). No difference in Lachman, pivot shift, or age was noted between the injured braced and nonbraced skiers. Nonbraced ACLr skiers were 2.74 times more likely to suffer subsequent injury than braced skiers (OR = 2.74 [CI: 1.2 to 4.9]). Controlling for Lachman, pivot shift, and age, logistic regression modeling identified non-bracing as significant independent, multivariate risk factor for subsequent knee injury in the professional, high demand skier.
Conclusions:  In this study population, non-braced ACL reconstructed skiers were at increased risk of subsequent knee injury. Whether the protective effect of functional bracing can be extrapolated to other high demand patients is yet to be determined.
Keywords:
  1. Ligament
 Categories:
  1. CLINICAL: Knee - ACL