In order to optimize the healing process for many patients after a knee ligament injury, or to treat patients with malalignment and ipsilateral arthritis, knee braces are an essential component of ensuring that one achieves a maximal outcome. Knee braces can be an effective means to maximize healing, both for nonoperative treatment after ligament injuries, as well as for postoperative treatment after knee ligament reconstructions or repairs. In general, there are three main braces that we use to treat knee ligament and other pathology to maximize outcomes.
CTi Knee Brace
The CTI knee brace is our workhorse brace for patients who have sustained knee ligament injuries which can be treated without surgery, such as a MCL tear, and for preoperative and postoperative treatment of ACL and/or collateral ligament reconstructions in patients. These braces provide stability in side-to-side activities, as well as for front to back activities (anterior to posterior) and are an essential part of maximizing healing.
We utilize these braces for nonoperative treatment of MCL tears as well as in patients before surgery when they are going through prehabilitation to get their knee ready for surgery and also postoperatively after ACL reconstructions and many of the other knee ligament reconstructions around the knee.
They are also used long term in patients who ski and who have undergone ACL reconstructions as the use of braces have been shown to dramatically decrease the risk that one will tear their ACL reconstruction graft while skiing.
Fitting Your CTi Knee Brace For The First Time
Unloader Knee Brace
Unloader braces have several different potential uses, with the most common one being for patients who are bowlegged (varus alignment) and have arthritis on the inside part of their knee, called the medial compartment. A medial unloader brace helps to effectively position the leg to relieve stress on the medial compartment and we have found this to be very effective in providing relief to patients who are suffering from medial compartment arthritis. Some of these patients may only have arthritis on the inside part of the knee and may be candidates for a proximal tibial osteotomy. In these cases, we will use the unloader brace as a screen to verify if their pain can be effectively relieved with a medial unloader brace. If so, we can offer them a potential proximal tibial osteotomy to treat their pathology.
In other cases, we find that patients may have advanced arthritis, are not candidates for an osteotomy, and are not ready for a knee replacement. Patients with advanced medial compartment arthritis may find that a medial unloader brace allows them to increase their function, lose weight, and strengthen their lower extremities so they can function better and put off the need for a total knee replacement. Similarly, patients who are knock-kneed (valgus alignment) with lateral compartment arthritis may find that a lateral unloader brace and effectively decrease their knee pain to increase their function and general activities, such as golf, hike or walk longer distances.
Other uses for unloader braces are in patients who may have a MCL (lateral unloader) or LCL/FCL (medial unloader) injury that it is difficult to determine if it is a high grade partial or a complete ligament tear. The use of the unloader brace may help to determine if a patient has any significant symptoms from this pathology and can help to screen if the patient would benefit from surgery.
Other uses of unloader braces are in patients who have undergone revision ligament reconstructions or in patients with high body mass present, and the unloader brace can be used to help take the stress off of a knee ligament reconstruction, especially revision reconstruction, while it is healing.
Our other most common use for the medial unloader brace is for patients who are bowlegged and have a medial meniscus root repair. In these patients, we have found that the medial unloader brace helps to unload the stresses on the root repair and to increase the chance of healing and having a good successful outcome. Our studies, and other studies, have found that we do not necessarily need to have these patients undergo a proximal tibial osteotomy and that solely having an effectively performed medial meniscus root repair can help relieve the symptoms and increase their function after surgery. .
Instructions on how to use your Unloader Brace
Rebound ACL and PCL Knee Brace
The Rebound PCL brace was invented in collaboration with Dr. LaPrade and Ossur. This brace has been reported to be the only true dynamic brace. It has been found to be extremely effective in reducing the forces on a PCL reconstruction graft to maximize the chance of healing of the PCL grafts. This is important because PCL reconstructions historically did not do well, and we have found that the use of our anatomic double-bundle PCL reconstructions, combined with a PCL Rebound brace, restores patient’s outcomes to the same outcomes that can be seen with ACL reconstructions. This novel brace is felt to be an essential component of our ability to restore patient’s function with PCL tears.
In addition, the patients who have an acute PCL tear, that does not occur with other knee ligament injuries, the use of the dynamic PCL brace has been found to position the knee into such an adequate position that some patients can heal their PCL without the need for surgery. Thus, for high level athletes, we find that the use of this brace can sometimes be effective in restoring their function and trying to maximize their chance of not requiring a PCL reconstruction. In general, these are patients who have stress x-rays that are 8 mm or less for their PCL stress x-rays.
Finally, for dynamic PCL braces, we commonly see patients that have chronic high grade partial PCL tears, with stress x-rays of 5 to 8 mm, where it is difficult to determine if their inability to go down hills, down stairs, or decelerate is due to muscle weakness that can be addressed with therapy or if the PCL tear is causing them the significant functional limitations. In these patients we will commonly place them into a dynamic PCL brace as a screen. Almost always, the patients can tell within hours whether the PCL deficiency is the underlying issue and we have found that these patients are very effectively treated with a double-bundle PCL reconstruction to restore their function.
The Rebound ACL brace, which has just recently been developed, was invented based upon the excellent response that we had with improving patient function with a dynamic PCL brace. In many circumstances, patients may have an ACL reconstruction that has a higher chance of failure. In these patients, using a dynamic PCL brace to best decrease the force on an ACL reconstruction graft can maximize their chance of healing. These include patients who have allograft ACL reconstructions, patients with hamstring or other soft tissue reconstructions who have generalized laxity (usually with a heel height of 5 cm or more), some quadriceps tendon ACL reconstruction grafts, and revision ACL reconstruction grafts. The use of the dynamic ACL Rebound brace will decrease the force on these reconstructions and we feel that our bench-to-bedside research will ultimately demonstrate that our outcomes will be significantly improved in these cases also.
Rebound ACL and PCL User Instructions
In summary, the use of both preoperative and postoperative knee bracing is an essential part of our knee ligament and early arthritis, or even advanced arthritis, treatment and screening. We have found them to be extremely effective in helping to improve patient outcomes and have ongoing research to continue to advance the science behind the use of knee ligament braces.
*Please Note: Dr. Laprade does not receive any reimbursement, royalties or promotional funds from Ossur knee braces or their affiliates. He encourages the use of these specific braces, due to their support, quality, and overall features. Through extensive trial and error we have found these braces to be the best choice for patients recovering from knee surgery.