1
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Novaes M, Carvalho A, Sauer JF, Brech GC, Helito CP, João SMA. Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study. BMC Musculoskelet Disord 2022; 23:383. [PMID: 35468775 PMCID: PMC9040202 DOI: 10.1186/s12891-022-05347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Several studies have shown persistent postural control deficits and rotatory instability in patients after isolated Anterior Cruciate Ligament (ACL) reconstruction. There is evidence to support that the Anterolateral Ligament (ALL) plays an important role in the remaining anterolateral rotatory laxity of the knee. There are no further evidences in order to understand how patients with a combined ACL + ALL reconstruction surgery indication behave regarding postural control. The aim of this cross-sectional study was to assess if patients with a clinical indication for the combined ACL + ALL surgery showed a deficient postural control in single leg stance compared to subjects with a regular ACL reconstruction indication and to a control group. Methods An assessment of static postural control on single leg stance was performed on a force plate, with eyes open and closed, and the center of pressure (COP) displacement variables were analyzed: maximum and mean amplitude in anteroposterior (AP) and in mediolateral (ML) direction; mean velocity of displacement and area of displacement. Eighty-nine male individuals participated and were divided into 3 groups: ACL Group, ACL + ALL Group and Control Group. Results The ACL+ ALL Group showed significantly greater COP displacement in most variables in the injured leg for the eyes closed test, compared to the ACL Group, as detailed: Total ML displacement (9.8 ± 6.77 vs. 13.98 ± 6.64, p < 0.001); Mean ML displacement (2.58 ± 2.02 vs. 3.72 ± 1.99, p < 0.001); Total AP displacement (9.5 ± 3.97 vs. 11.7 ± 3.66, p = 0.001); Mean AP displacement (1.77 ± 0.87 vs. 2.27 ± 0.86, p = 0.001); Area of displacement (111.44 ± 127.3 vs. 183.69 ± 131.48, p < 0.001). Conclusion Subjects with a clinical indication for ACL + ALL combined reconstruction surgery showed increased COP displacement compared to patients with indication for an ACL isolated reconstruction surgery.
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Affiliation(s)
- Marilia Novaes
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil. .,Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Adriana Carvalho
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil.,Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana F Sauer
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil.,Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme C Brech
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil
| | - Camilo P Helito
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia M A João
- Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil
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2
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Ma R, Sheth C, Fenkell B, Buyuk AF. The Role of Bracing in ACL Injuries: The Current Evidentiary State of Play. J Knee Surg 2022; 35:255-265. [PMID: 35088398 DOI: 10.1055/s-0042-1742304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anterior cruciate ligament (ACL) injuries and surgeries are both increasing in incidence. A notable rate of reinjury and failure does occur after ACL surgery. As a result, interventions that may reduce ACL injury or reinjury are needed and are active areas of innovation. Knee bracing as a strategy to either prevent primary ACL injury, reduce reinjury, or failure after ACL surgery is common. The evidence for bracing around ACL injuries is not straightforward. Clinicians therefore need to understand the relevant literature on bracing around ACL injuries to make personalized decisions for individuals who may be at risk for ACL injury. The purpose of this review is to provide an overview on bracing for ACL injuries and summarize the current available clinical evidence for its use in ACL injuries.
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Affiliation(s)
- Richard Ma
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
| | - Chirag Sheth
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
| | - Blake Fenkell
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
| | - Abdul Fettah Buyuk
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri - Columbia, Columbia, Missouri
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3
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Haris A, Beng Chye Tan V. Effectiveness of bilateral single-hinged knee bracing in osteoarthritis: A finite element study. Proc Inst Mech Eng H 2021; 235:873-882. [PMID: 33913345 DOI: 10.1177/09544119211012493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effectiveness of knee braces remains to be identified. Therefore, the purpose of this study was to investigate the effectiveness of bilateral single-hinged knee bracing in knee osteoarthritis (OA) using finite element (FE) method. A three-dimensional FE model consisted of main model (knee-brace structure) and submodel (strap-muscle system) was developed. The submodel was used to convert the elastic strap-muscle interaction into an equivalent stiffness value required by the main model. Adding 100 N · mm/rad torsion spring to the brace with 5 kPa strap pressure lowered maximum von Mises stress in the knee OA components at a flexion angle greater than or equal to 90°. Separately, employing 10% brace pre-tension to the brace with 5 kPa strap pressure started to reduce stresses at a flexion angle of 70°. The configuration involving a combination of 10% brace pre-tension and 300 N · mm/rad torsion spring with 30 kPa strap tightness produced stress reduction over the entire range from 0° to 100° flexion angle. The basic bilateral single-hinged knee brace has shown to reduce stresses in the knee OA at high flexion angles only. Compared to the torsion spring, the brace pre-tension has shown to provide more significant benefits (i.e. stress reduction at lower flexion angles). The most sophisticated effects were achieved when the torsion spring was used in combination with the brace pre-tension. These two features can be potentially used for the development of an active knee brace if they can be modulated at different flexion angles or during the gait cycle.
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Affiliation(s)
- Andi Haris
- Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
| | - Vincent Beng Chye Tan
- Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
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4
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Baige K, Noé F, Bru N, Paillard T. Effects of Compression Garments on Balance Control in Young Healthy Active Subjects: A Hierarchical Cluster Analysis. Front Hum Neurosci 2020; 14:582514. [PMID: 33281583 PMCID: PMC7689056 DOI: 10.3389/fnhum.2020.582514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/16/2020] [Indexed: 01/13/2023] Open
Abstract
There is controversy about the influence of compression garments on balance control. A positive influence was reported in elderly and injured individuals, whereas no beneficial effects were observed in young healthy active subjects, which is likely due to the large inter-individual differences in these subjects. Hence, this study investigated the acute effects of compression garments on balance control in young healthy active subjects by addressing the issue of heterogeneity of individuals’ responses to the wearing of compression garments. Thirteen young, healthy, active subjects were recruited. They stood on a force plate which recorded the center of foot pressure displacements in a monopedal stance with the eyes closed and on a wobble board with the eyes open, while wearing compression garments or not. Statistics were first calculated with the data from the whole sample. A hierarchical cluster analysis was also performed in order to categorize the participants’ behaviors into subgroups with similar characteristics. The whole group analysis showed that there were no significant effects attributed to compression garments. The clustering analysis identified distinct and homogeneous subgroups of participants. Only participants who swayed the more at baseline benefited from the wearing of compression garments to improve their balance control. These participants might have either a gravity-dependent preferred sensorimotor strategy with an exploratory postural behavior or poorer balance/proprioceptive abilities. Since poor balance control is a predictor of sports injury risk, wearing compression garments during sports practice could be viewed as a potential prevention strategy for individuals at risk.
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Affiliation(s)
- Kévin Baige
- Laboratoire Mouvement, Equilibre, Performance et Santé (EA 4445), Université de Pau et des Pays de l'Adour/E2S UPPA, Tarbes, France
| | - Frédéric Noé
- Laboratoire Mouvement, Equilibre, Performance et Santé (EA 4445), Université de Pau et des Pays de l'Adour/E2S UPPA, Tarbes, France
| | - Noëlle Bru
- Laboratoire de Mathématiques et de leurs Applications, UMR CNRS 5142, Université de Pau et des Pays de l'Adour/E2S UPPA, Pau, France
| | - Thierry Paillard
- Laboratoire Mouvement, Equilibre, Performance et Santé (EA 4445), Université de Pau et des Pays de l'Adour/E2S UPPA, Tarbes, France
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5
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Wearing compression garments differently affects monopodal postural balance in high-level athletes. Sci Rep 2020; 10:15331. [PMID: 32948796 PMCID: PMC7501239 DOI: 10.1038/s41598-020-72347-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022] Open
Abstract
This study investigated the acute effects of compression garments (CG) on balance control in elite athletes. 15 male professional handball players were recruited. They had to stand as motionless as possible in a monopedal stance on a force plate with the eyes closed and on a wobble board with the eyes open, while wearing CG or not. Centre of foot pressure mean velocity and surface area were calculated. Statistics were first calculated with the data from the whole sample. A hierarchical cluster analysis was also performed in order to categorize the participants’ behaviours into subgroups with similar characteristics. The whole group analysis showed that there were no significant effects attributed to CG. The clustering analysis identified two distinct and homogeneous subgroups of participants. Only athletes with the best balance abilities at baseline could benefit from CG wearing to improve their balance control. These athletes, who swayed less and were more sensitive to somatosensory manipulation due to CG wearing, seem to control balance by adopting a support-dependent preferred sensorimotor tactic. Our findings suggest that amongst high-level athletes, the ability to benefit from CG wearing to improve balance control seems to depend on participants’ intrinsic balance skills and/or preferred sensorimotor tactics.
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6
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Focke A, Steingrebe H, Möhler F, Ringhof S, Sell S, Potthast W, Stein T. Effect of Different Knee Braces in ACL-Deficient Patients. Front Bioeng Biotechnol 2020; 8:964. [PMID: 32984272 PMCID: PMC7479127 DOI: 10.3389/fbioe.2020.00964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/24/2020] [Indexed: 01/13/2023] Open
Abstract
Knee braces are often used during rehabilitation after ACL injury. There are two main concepts, rigid and soft braces, but studies comparing the two show conflicting results. Most studies used movement tasks with low translational or rotational loads and did not provide joint kinematics. Therefore, the purpose of this study was to investigate the influence of two different knee braces (rigid vs. soft) on knee joint kinematics in ACL-deficient patients compared to an unbraced control condition using two tasks (walking and 180° cutting) provoking knee movements in the frontal and transverse planes. 17 subjects with ACL-deficient knees participated in this study. 3D knee joint kinematics were recorded. To provoke frontal plane knee joint motion a laterally tilting plate was applied during a walking task. Both braces reduced the maximum valgus angle compared to the unbraced condition, stabilizing the knee joint against excessive valgus motion. Yet, no differences in peak abduction angle between the two braces were found. However, a significant extension deficit was observed with the rigid brace. Moreover, both braces increased transverse plane RoM and peak internal rotation angle, with the effects being significantly larger with the rigid brace. These effects have been associated with decreased knee stability and unphysiological cartilage loading. Therefore, the soft brace seems to be able to limit peak abduction with a lesser impact on physiological gait compared to the rigid brace. The cutting task was selected to provoke transverse plane knee movement and large external knee rotation was expected. However, none of the braces was able to reduce peak external knee rotation. Again, an increase in transverse plane RoM was observed with both braces. Based on these results, no brace outmatched the other in the second task. This study was the first attempt to clarify the effect of brace design for the stabilization of the knee joint during movements with frontal and transverse plane loading. However, to provide physicians and patients with a comprehensive guideline for brace usage, future studies will have to extent these findings to other daily or sportive movement tasks.
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Affiliation(s)
- Anne Focke
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Hannah Steingrebe
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.,Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Felix Möhler
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Steffen Ringhof
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.,Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Stefan Sell
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.,Joint Center Black Forest, Neuenbürg, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.,ARCUS Clinics Pforzheim, Pforzheim, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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7
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Hosp S, Csapo R, Heinrich D, Hasler M, Nachbauer W. Does Kinesiology tape counter exercise-related impairments of balance in the elderly? Gait Posture 2018; 62:167-172. [PMID: 29550696 DOI: 10.1016/j.gaitpost.2018.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/25/2018] [Accepted: 03/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Maintaining balance is an essential requirement for the performance of daily tasks and sporting activities, particularly in older adults to prevent falls and associated injuries. Kinesiology tape has gained great popularity in sports and is frequently used as a tool for performance enhancement. However, there is little research investigating its influence on balance. RESEARCH QUESTION The purpose of this study was to evaluate the effect of Kinesiology tape on dynamic balance, postural stability and knee proprioception after physical activity in healthy, older adults. METHODS Twelve physically active, healthy men aged 63-77 years performed the test on two separate days, with and without Kinesiology tape at the knee joint (prospective intervention with cross-over design). Dynamic balance during an obstacle-crossing task, postural stability in a single-leg stance test, and knee joint position sense as a measure of proprioception were examined before and after 30 min of downhill walking on a treadmill. The influences of taping condition and physical activity on all parameters were statistically tested using factorial ANOVAs. RESULTS Factorial ANOVA revealed significant time × taping condition interaction effects on all performance parameters (p < 0.05), indicating that the exercise-related changes in dynamic balance, postural stability and knee proprioception differed between the two taping conditions. The deterioration of performance was always greater when no tape was used. SIGNIFICANCE This study demonstrated that physical exercise significantly deteriorated dynamic balance, postural stability and knee proprioception in older men. These effects can be attenuated through the usage of Kinesiology tape. By preventing exercise-related impairments of balance, Kinesiology tape might help reduce the risk of sports-associated falls and associated injuries.
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Affiliation(s)
- Simona Hosp
- Centre of Technology of Ski and Alpine Sports, Fürstenweg 185, 6020 Innsbruck, Austria.
| | - Robert Csapo
- Centre of Technology of Ski and Alpine Sports, Fürstenweg 185, 6020 Innsbruck, Austria; Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
| | - Dieter Heinrich
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
| | - Michael Hasler
- Centre of Technology of Ski and Alpine Sports, Fürstenweg 185, 6020 Innsbruck, Austria.
| | - Werner Nachbauer
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria.
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8
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Effects of training on postural control and agility when wearing socks of different compression levels. BIOMEDICAL HUMAN KINETICS 2017. [DOI: 10.1515/bhk-2017-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Study aim: The aim of this study was to evaluate the effects of training while wearing socks differing in compression level (clinical, sub-clinical, regular) on performance of static and dynamic balancing and agility tasks in healthy, physically active people. We sought to understand whether socks with different compression properties supported postural regulation and agility task performance by enhancing somatosensory perception, unskewed by specific age range effects. Material and methods: Participants comprised 61 adults aged 18-75 years, divided into three groups (two experimental groups wearing clinical or sub-clinical level compression socks, and one control group wearing regular non-compression socks during training). An 8-week (2 × 1h per week) intervention programme was administered to train static and dynamic balance and postural control, leg strength and agility. Results: A mixed model ANOVA revealed no differences in static and dynamic balance and postural control and agility performance between clinical, sub-clinical, and control groups before and after training. All groups significantly improved their test performance, suggesting that training had some benefit on motor performance. Conclusions: These results raised interesting questions requiring further investigation to examine the effects of wearing socks (with and without different levels of compression) on motor behaviours in specific groups of elderly vs. young participants, in physically active vs. less physically active people, and in performance settings outside standardized laboratory tests to study applications in natural performance environments.
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9
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Hosp S, Folie R, Csapo R, Hasler M, Nachbauer W. Eccentric Exercise, Kinesiology Tape, and Balance in Healthy Men. J Athl Train 2017; 52:636-642. [PMID: 28418696 DOI: 10.4085/1062-6050-52.3.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Deficits in balance have been identified as a possible risk factor for knee injuries in athletes. Despite a lack of evidence for its effectiveness, kinesiology tape (KT) is widely used to prevent knee injuries. OBJECTIVE To investigate the influence of KT at the knee joint on balance ability in healthy men after eccentric exercise. DESIGN Crossover study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve young men with no history of lower limb injury volunteered for the study (age = 23.3 ± 2.6 years). All participants were students enrolled in a sports science program. INTERVENTION(S) Participants performed the balance test with and without KT at the knee joint on 2 separate days. MAIN OUTCOME MEASURE(S) The ability to maintain balance was assessed during a single-legged-stance test using a computerized balance-stability test system. The test was performed before and after 30 minutes of downhill walking on a treadmill. RESULTS Eccentric exercise resulted in a deterioration of balance ability, which was attenuated by the use of KT. Further analyses revealed that the effectiveness of KT depended on the participant's balance status, with the preventive effect being greater in participants presenting with poorer baseline balance ability. CONCLUSIONS Applied to the knee joint, KT counteracted the exercise-related deterioration of balance ability observed when no tape was used. Participants presenting with below-average balance ability received more benefit from KT. By preventing exercise-related impairment of balance ability, KT might help to reduce the risk of sport-associated knee injuries.
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Affiliation(s)
- Simona Hosp
- Centre of Technology of Ski and Alpine Sports, Innsbruck, Austria
| | - Ramona Folie
- Department of Sport Science, University of Innsbruck, Austria
| | - Robert Csapo
- Department of Sport Science, University of Innsbruck, Austria
| | - Michael Hasler
- Centre of Technology of Ski and Alpine Sports, Innsbruck, Austria
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10
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Woo MT, Davids K, Liukkonen J, Orth D, Chow JY, Jaakkola T. Effects of different lower-limb sensory stimulation strategies on postural regulation-A systematic review and meta-analysis. PLoS One 2017; 12:e0174522. [PMID: 28355265 PMCID: PMC5371369 DOI: 10.1371/journal.pone.0174522] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/10/2017] [Indexed: 11/23/2022] Open
Abstract
Systematic reviews of balance control have tended to only focus on the effects of single lower-limb stimulation strategies, and a current limitation is the lack of comparison between different relevant stimulation strategies. The aim of this systematic review and meta-analysis was to examine evidence of effects of different lower-limb sensory stimulation strategies on postural regulation and stability. Moderate- to high- pooled effect sizes (Unbiased (Hedges’ g) standardized mean differences (SMD) = 0.31–0.66) were observed with the addition of noise in a Stochastic Resonance Stimulation Strategy (SRSS), in three populations (i.e., healthy young adults, older adults, and individuals with lower-limb injuries), and under different task constraints (i.e., unipedal, bipedal, and eyes open). A Textured Material Stimulation Strategy (TMSS) enhanced postural control in the most challenging condition—eyes-closed on a stable surface (SMD = 0.61), and in older adults (SMD = 0.30). The Wearable Garments Stimulation Strategy (WGSS) showed no or adverse effects (SMD = -0.68–0.05) under all task constraints and in all populations, except in individuals with lower-limb injuries (SMD = 0.20). Results of our systematic review and meta-analysis revealed that future research could consider combining two or more stimulation strategies in intervention treatments for postural regulation and balance problems, depending on individual needs.
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Affiliation(s)
- Mei Teng Woo
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- School of Sports, Health and Leisure, Republic Polytechnic, Singapore, Singapore
- * E-mail:
| | - Keith Davids
- Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, United Kingdom
| | - Jarmo Liukkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Dominic Orth
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherland
| | - Jia Yi Chow
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Timo Jaakkola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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11
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Torres BT, Fu YC, Sandberg GS, Budsberg SC. Pelvic limb kinematics in the dog with and without a stifle orthosis. Vet Surg 2017; 46:642-652. [PMID: 28198549 DOI: 10.1111/vsu.12634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a method of evaluating 3-dimensional joint motion in dogs with a stifle orthosis. STUDY DESIGN Experimental. ANIMALS Six healthy dogs. METHODS Three-dimensional pelvic limb joint motion was recorded with and without a stifle orthosis. Kinematic data were collected from dogs at a walk and trot for the hip, stifle, and tarsus prior to, and after application of, a stifle orthosis. Data were also obtained for the orthosis alone. Comparisons were made between the braced and unbraced limb, and between the braced limb and the orthosis alone. Complete waveforms, kinematic, and temporospatial variables were compared. RESULTS Gait waveforms differed between braced and unbraced limbs for all joints and planes of motion (P < .05), as well as between the braced stifles and the orthosis alone at both a walk and trot. However, joint ROM was inconsistently altered. The effect of bracing on stifle ROM was limited to a reduced extension at the end of stance. Adjacent joint ROM was affected by the stifle orthosis. Temporospatial variables were predominantly affected while walking. CONCLUSIONS The restrictive motion of the stifle orthosis is not fully translated to the underlying joint, based on the limited differences between the motion of braced and unbraced stifles. This effect varies with plane of motion and phase of the gait cycle, with most changes in stifle motion being detected during the stance phase. The stifle orthosis had an equal or greater effect on the motion of adjacent joints, especially the tarsus.
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Affiliation(s)
- Bryan T Torres
- The Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Yang-Chieh Fu
- The Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, Mississippi
| | - Gabriella S Sandberg
- The Department of Small Animal Medicine and Surgery, University of Georgia, College of Veterinary Medicine, Athens, Georgia
| | - Steven C Budsberg
- The Department of Small Animal Medicine and Surgery, University of Georgia, College of Veterinary Medicine, Athens, Georgia
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12
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Indorato D, Sturgil R. An Assessment of Rehabilitation Protocols following Anterior Cruciate Ligament Reconstruction: A Systematic Review. Rehabil Process Outcome 2016. [DOI: 10.4137/rpo.s40054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The present study provided a systematic review with meta-analysis of randomized controlled trials involving the effectiveness of various rehabilitation methods that have been implemented for the treatment of anterior cruciate ligament reconstruction (ACLR). The review of the literature revealed the following as evidence for effective ACLR rehabilitation: early intervention strategy focused on restoring range of motion, muscle strength, and ligament stability with the utilization of closed kinetic chain exercises. The literature supports the use of dynamic intraligamentary stabilization, which should also be implemented in the rehabilitation protocol within the first three months after surgery. The research suggests that the patient should undergo at least 30-90 minutes of cryotherapy immediately following ACLR surgery. There is also some evidence regarding the effectiveness of neuromuscular rehabilitation training programs, but further investigations are needed. Future research should consider the timing of rehabilitation as well as supplemental rehabilitation exercises to continue to improve the quality of care delivered to patients following ACLR.
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13
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Fernandes TL, Felix ECR, Bessa F, Luna NMS, Sugimoto D, Greve JMD, Hernandez AJ. Evaluation of static and dynamic balance in athletes with anterior cruciate ligament injury - A controlled study. Clinics (Sao Paulo) 2016; 71:425-9. [PMID: 27626471 PMCID: PMC4975786 DOI: 10.6061/clinics/2016(08)03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/15/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Anterior cruciate ligament injury leads to adaptive responses to maintain postural control. However, there is no consensus regarding whether leg dominance also affects postural control in athletes with anterior cruciate ligament injury. The purpose of this study was to evaluate dynamic and static postural control among athletes with and without anterior cruciate ligament injury to the dominant leg. METHODS Twenty-eight athletes, twenty-one males and seven females aged 15-45 years, were allocated to one of two groups: the anterior cruciate ligament injury group (26±3 years) or the control group without anterior cruciate ligament injury (25±6.5 years). All subjects performed one legged stance tests under eyes open and eyes closed conditions and squat and kick movement tests using a postural control protocol (AccuSwayPlus force platform, Massachusetts). The center of pressure displacement and speed were measured by the force platform. In addition, the distance traveled on the single-leg hop test was assessed as an objective measure of function. RESULTS Significantly greater mediolateral sway was found under the eyes closed condition (p=0.04) and during squat movement (p=0.01) in the anterior cruciate ligament injury group than in the control group. Analysis of the single-leg hop test results showed no difference between the groups (p=0.73). CONCLUSION Athletes with anterior cruciate ligament injury had greater mediolateral displacement of the center of pressure toward the dominant leg under the eyes closed condition and during squat movement compared to control athletes.
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Affiliation(s)
- Tiago Lazzaretti Fernandes
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Grupo de Medicina do Esporte - FIFA, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Laboratório de Cinesiologia (LEM), São Paulo/SP, Brazil
- Harvard Medical School, Massachusetts General Hospital, Department of Orthopedic Surgery, Bioengineering Laboratory, Boston, MA, USA
- E-mail:
| | - Ellen Cristina Rodrigues Felix
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Grupo de Medicina do Esporte - FIFA, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Laboratório de Cinesiologia (LEM), São Paulo/SP, Brazil
| | - Felipe Bessa
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Grupo de Medicina do Esporte - FIFA, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Laboratório de Cinesiologia (LEM), São Paulo/SP, Brazil
| | - Natália MS Luna
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Grupo de Medicina do Esporte - FIFA, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Laboratório de Cinesiologia (LEM), São Paulo/SP, Brazil
| | - Dai Sugimoto
- Boston Children’s Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, MA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Júlia Maria D’Andrea Greve
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Grupo de Medicina do Esporte - FIFA, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Laboratório de Cinesiologia (LEM), São Paulo/SP, Brazil
| | - Arnaldo José Hernandez
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Grupo de Medicina do Esporte - FIFA, São Paulo/SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Laboratório de Cinesiologia (LEM), São Paulo/SP, Brazil
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Rodríguez-Merchán EC. Knee Bracing After Anterior Cruciate Ligament Reconstruction. Orthopedics 2016; 39:e602-9. [PMID: 27203412 DOI: 10.3928/01477447-20160513-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 02/26/2015] [Indexed: 02/03/2023]
Abstract
Although some articles in the literature are in favor of the use of a postoperative brace after anterior cruciate ligament (ACL) reconstruction, this review found that several systematic reviews and other reports on the topic do not support the use of a postoperative brace after ACL reconstruction. There is no scientific evidence so far to support the routine use of a functional knee brace following a successful ACL reconstruction in the postoperative course. Most authors believe that bracing is not necessary. There is insufficient evidence to inform current practice. Good-quality randomized trials are required to remedy this situation. Future studies should better define the role of a brace following ACL surgery. A search of MEDLINE for articles published between January 1, 1995, and September 30, 2013, was performed. Key search terms used were ACL reconstruction and knee brace. Ninety-one articles were found, but only 28 focused on the subject of bracing after ACL reconstruction and were selected for this review. Several systematic reviews and randomized, controlled trials on the topic do not recommend the use of postoperative brace after ACL reconstruction. Postoperative bracing after ACL reconstruction does not seem to help with pain, function, rehabilitation, and stability. The literature does not support the use of a postoperative brace following ACL reconstruction. [Orthopedics. 2016; 39(4):e602-e609.].
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Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med 2016; 7:21-32. [PMID: 26955296 PMCID: PMC4772947 DOI: 10.2147/oajsm.s72332] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends.
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Affiliation(s)
- John Nyland
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA; Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA
| | - Alma Mattocks
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - Shane Kibbe
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA
| | - Alaa Kalloub
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; Shea Orthopedic Group, Louisville, KY, USA
| | - Joe W Greene
- Norton Orthopedic and Sports, Louisville, KY, USA
| | - David N M Caborn
- Department of Orthopedic Surgery, University of Louisville, Louisville, KY, USA; Shea Orthopedic Group, Louisville, KY, USA
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Palm HG, Schlumpberger S, Riesner HJ, Friemert B, Lang P. [Influence of anterior cruciate reconstruction on postural stability: A pre- and postoperative comparison]. Unfallchirurg 2014; 118:527-34. [PMID: 24723058 DOI: 10.1007/s00113-013-2521-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ruptures of the anterior cruciate ligament (ACL) lead to an anteromedial rotational instability in the knee joint and, thus, to a deterioration of the patient's ability to stand (postural control). It still remains unclear whether postural control can be restored by ACL reconstruction. The aim of this study was to investigate the effect of a unilateral ACL graft on the ability to stably stand on the injured leg using computer-aided dynamic posturography (CDP); the stability indices on standing on one leg were compared pre- and postoperatively. PATIENTS AND METHODS A total of 25 patients were studied after unilateral ACL injury and subsequent ACL reconstruction using CDP. The average time of follow-up was 608 days (range 357-821 days). The ability to stably stand on the healthy and injured leg was compared and evaluated for significant differences. RESULTS There was a significant improvement of postural control after ACL reconstruction. The Overall Stability Index (OSI) for the leg with ACL rupture was 3.7° ± 1.6° preoperatively and 3.0° ± 1.1° postoperatively (p < 0.05). In the postoperative comparison with the healthy leg, the value in the operated leg was 3.0° ± 1.1° and the healthy leg was 3.0° ± 1.4° (p = 0.99). CONCLUSIONS ACL replacement can be improve stability compared to the preoperative value by about 21% and even the stability level of the contralateral healthy knee can be achieved.
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Affiliation(s)
- H-G Palm
- Klinik für Unfallchirurgie und Orthopädie, Unfallchirurgische Forschungsgruppe, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland,
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Jeon HS, Hwang S, Woo YK. The effect of ankle and knee immobilization on postural control during standing. Knee 2013; 20:600-4. [PMID: 23142274 DOI: 10.1016/j.knee.2012.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 08/07/2012] [Accepted: 09/03/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study examined the effects of ankle and knee joint immobilization on postural control in healthy young adults while standing. METHODS The 24 participants included in this study participated in postural standing tests under four different constraint conditions: free joints, ankle immobilization only, knee immobilization only, and ankle-knee immobilization. Tests were performed using a commercial balancing equipment (Biodex(TM), Inc., NY, USA) and software. RESULTS The overall limit-of-stability score and duration to completion of task were obtained at 75% limit-of-stability (moderate level of difficulty). The overall limit-of-stability score of free joints (34.5±9.1) were significantly different with the ankle immobilization only (26.0±11.6), and ankle-knee immobilization (26.4±7.4) conditions. The test duration increased in the following order: free joints (57.8±10.9), knee immobilization only (62.5±14.0), ankle immobilization only (68.0±14.9), and ankle-knee immobilization (69.4±17.7). The duration of the free joint condition greatly decreased than ankle immobilization only and ankle-knee immobilization conditions. CONCLUSIONS The ankle and knee joints have sufficient range of motion to prevent falls related to decrease postural stability due to insufficient range of motion or to improve postural stability.
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Affiliation(s)
- Hye-Seon Jeon
- Department of Physical Therapy, College of Health Science, Yonsei University. Institute of Health Science, Yonsei University, Republic of Korea
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[Anterior cruciate ligament ruptures and postural control: correlation of functional knee scores with computerized dynamic posturography]. DER ORTHOPADE 2013; 42:100-6. [PMID: 23306527 DOI: 10.1007/s00132-012-2040-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Quantification of postural stability deficits after anterior cruciate ligament (ACL) rupture requires a complex measurement process, the so-called computerized dynamic posturography (CDP). It would be desirable if the decrease in postural stability caused by ACL rupture could be estimated by simpler functional scores. The aim of this study was therefore to review the currently available standard knee scores for the suitability to assess postural stability. PATIENTS AND METHODS In this study 58 patients with isolated unilateral ACL rupture were examined using CDP. The questionnaires used were Tegner, WOMAC, ADL-KOS, KOS-Sport, KSS and Lysholm scores. The values obtained were compared and correlated with the results of the CDP. In addition, a subgroup analysis of copers and non-copers was performed. RESULTS There was no significant correlation with the postural stability deficit for any of the scores examined in this study. Only the subjectively perceived instability correlated appreciably with the CDP with r=0.423. CONCLUSIONS All currently used scores for the investigation of patients with ACL rupture cannot give any information about the ability of postural balance. If patients complain about an increased subjective feeling of instability a close observation of postural stability using CDP is inevitable.
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A historical perspective of PCL bracing. Knee Surg Sports Traumatol Arthrosc 2013; 21:1064-70. [PMID: 22622778 DOI: 10.1007/s00167-012-2048-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/02/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Currently there are many functional knee braces but very few designed to treat the posterior cruciate ligament (PCL). No PCL braces have been biomechanically validated to demonstrate that they provide stability with proper force distribution to the PCL-deficient knee. The purpose of this review was to evaluate the history and current state of PCL bracing and to identify areas where further progress is required to improve patient outcomes and treatment options. METHODS A PubMed search was conducted with the terms "posterior cruciate ligament", "rehabilitation", "history", "knee", and "brace", and the relevant articles from 1967 to 2011 were analysed. A review of the current available PCL knee bracing options was performed. RESULTS Little evidence exists from the eight relevant articles to support the biomechanical efficacy of nonoperative and postoperative PCL bracing protocols. Clinical outcomes reported improvements in reducing PCL laxity with anterior directed forces to the tibia during healing following PCL tears. Biomechanics research demonstrates that during knee flexion, the PCL experiences variable tensile forces. One knee brace has been specifically designed and clinically validated to improve stability in PCL-deficient knees during rehabilitation. While available PCL braces demonstrate beneficial patient outcomes, they lack evidence validating their biomechanical effectiveness. CONCLUSIONS There is limited information evaluating the specific effectiveness of PCL knee braces. A properly designed PCL brace should apply correct anatomic joint forces that vary with the knee flexion angle and also provide adjustability to satisfy the demands of various activities. No braces are currently available with biomechanical evidence that satisfies these requirements. LEVEL OF EVIDENCE IV.
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