Effects of postoperative knee bracing on knee function and stability after anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Abstract

Purpose: The use of knee braces following anterior cruciate ligament reconstruction (ACLR) remains contentious. Although frequently prescribed in clinical settings, their effectiveness in enhancing postoperative recovery is uncertain. This study aimed to determine whether postoperative bracing after ACLR confers clinical benefits regarding knee function scores, pain, muscle strength, and joint stability, through a systematic review and meta-analysis.

Methods: A comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted through March 2025 to identify randomized controlled trials and case-control studies evaluating postoperative bracing after ACLR. Meta-analyses were performed using Review Manager (version 5.3) for the following outcomes: International Knee Documentation Committee (IKDC) objective score, Lysholm score, Tegner activity score, visual analogue scale (VAS) pain score, single-leg hop test, and side-to-side knee laxity. Bias risk evaluation was performed applying the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.

Results: A total of 785 participants across 11 studies were included, with 387 allocated to bracing and 388 to non-bracing groups. Meta-analysis revealed no significant differences between groups in IKDC objective score (odds ratio [OR] = 1.18; 95% confidence interval [CI], 0.65-2.14; p = 0.58), Lysholm score (mean difference [MD] = -0.30; 95% CI, -0.72 to 0.11; p = 0.15), Tegner score (MD = -0.22; 95% CI, -0.46 to 0.02; p = 0.07), VAS pain score (MD = 0.08; 95% CI, -0.15 to 0.32; p = 0.49), single-leg hop test (MD = 1.06; 95% CI, -0.01 to 2.14; p = 0.05), and anterior-posterior knee laxity (MD = -0.30; 95% CI, -0.72 to 0.11; p = 0.15). Subgroup analyses indicated significantly better Lysholm and Tegner scores among individuals without bracing when follow-up exceeded 2 years. No consistent differences were observed by graft type.

Conclusion: Postoperative bracing did not yield significant improvements in function, pain, strength, or stability following ACLR. Mid- to long-term outcomes (follow-up >2 years, up to 5 years) may favour non-bracing, indicating that routine brace use after ACLR is not warranted.

Level of evidence: Level II, systematic review.

Keywords: anterior cruciate ligament reconstruction; joint stability; knee brace; knee function; meta‐analysis.