Rehabilitation and functional outcomes in internally braced and standard ACL reconstructions

Purpose: The purpose of this study was to compare surgical outcomes in patients who underwent ACL reconstruction, with and without internal bracing, at 1-3, 4-7, and 8-12 months of postoperative physical therapy. Previous studies show that ACL reconstruction with internal bracing allows earlier and more aggressive rehabilitation. Therefore, it was hypothesized that patients with internal bracing would display superior surgical recovery compared to ACL reconstruction alone after adjusting for length of physical therapy.1-3 Methods: Patients who underwent ACL reconstruction and had a minimum two-year follow-up were included. Demographics including age, gender, use of internal bracing, and pre-operative level of activity were collected. Patient-reported outcomes were assessed using KOOS scores. Results: 46 patients underwent ACL reconstruction between January 2013 and December 2015. The mean age was 31.53 & PLUSMN; 8.37 years. Patients who received ACL reconstruction with internal bracing reported similar improvement in KOOS scores (mean = 42.82 & PLUSMN; 15.44; median = 46.39 [34.52-51.80]) compared to ACL reconstruction alone (mean = 38.18 & PLUSMN; 19.91; median = 40.17 [29.49-53.90]) (p = 0.475). Patients who received ACL reconstruction with internal bracing reported comparable improvement to ACL reconstruction alone at 0-3 months (Internal bracing: mean = 35.39 & PLUSMN; 15.26, median = 40.45 [26.49-47.73]; No internal bracing: mean = 42.51 & PLUSMN; 12.33, median = 39.32 [35.69-52.94], p = 0.4113), 4-7 months (Internal bracing: 41.96 & PLUSMN; 14.49, 45.55 [33.94-52.68]; No internal bracing: 30.64 & PLUSMN; 32.29, 41.65 [26.17-46.12], p = 0.7491) and 8+ months groups (Internal bracing: 63.36 & PLUSMN; 13.06, 63.36 [58.74-67.98]; No internal bracing: 47.05 & PLUSMN; 10.14, 47.05 [43.46-50.63]) (p = 0.6985). Conclusion: This study demonstrates no statistical difference in functional outcome scores when comparing pa-tients with internally braced ACL reconstruction compared to standard reconstruction. Therefore, the increased structural support provided by use of internal bracing in ACL reconstruction does not afford to quicker improvement in patient-reported recovery.