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Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The effectiveness of ACL functional knee braces to reduce meniscal and ACL strain after ACL injury or reconstruction is not well understood. A new dynamic knee tensioning brace system has been designed to apply an active stabilizing force to the knee. The ability of this system to reduce tissue strains is unknown. The purpose of this study was to test the ability of the dynamically tensioned brace to reduce strain in both the ACL and meniscus during rehabilitation activities.

Methods

A combined in vivo/in silico/in vitro method was used to study three activities: gait, double leg squat, and single leg squat. Muscle forces and kinematics for each activity were derived through in vivo motion capture and applied to seven cadaveric knee specimens fitted with custom braces. Medial meniscal strain and ACL strain were measured in ACL intact, deficient and reconstructed conditions.

Results

The brace lowered peak and average meniscal strain in ACL deficient knees (P < 0.05) by an average of 1.7%. The brace was also found to lower meniscal strain in reconstructed knees (1.1%) and lower ACL strain in ACL intact (1.3%) and reconstructed knees (1.4%) (P < 0.05).

Conclusions

This study supports the use of a brace equipped with a dynamic tensioning system to lower meniscal strain in ACL-deficient knees. Its use may help decrease the risk of subsequent meniscal tears in chronic ACL deficiency or delayed reconstruction. In ACL-intact and reconstructed knees, the brace may be beneficial in injury prophylaxis or in protecting the ACL graft following reconstruction. These results will aid clinicians make informed recommendations for functional brace use in patients with unstable knees.

Level of evidence

II.

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Abbreviations

ACL:

Anterior cruciate ligament

ATT:

Anterior tibial translation

DLS:

Double leg squat

DTS:

Dynamic tensioning system

DVRT:

Differential variable reluctance transducer

FKB:

Functional knee brace

SLS:

Single leg squat

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Acknowledgements

This work was supported by a grant from Ossur Inc. One of the authors is an employee of Ossur Inc.

Author information

Authors and Affiliations

  1. Sunnybrook Health Sciences Centre, University of Toronto, 343 - 43 Wellesley St. E., Toronto, ON, M4Y 1H1, Canada

    Sebastian Tomescu, David Wasserstein & Cari Whyne

  2. Structural Biomechanics Laboratory, Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave W. E3 2115, Waterloo, ON, N2L 3G1, Canada

    Sebastian Tomescu, Ryan Bakker, Mayank Kalra & Naveen Chandrashekar

  3. Ossur Americas, Lake Forest, USA

    Micah Nicholls

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  1. Sebastian Tomescu
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  2. Ryan Bakker
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  7. Naveen Chandrashekar
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Contributions

ST was involved in all phases of the research project. RB was involved in all phases of the research project. DW was involved in study design, in vitro testing and paper writing/editing. MK was involved in in vitro testing and paper writing/editing. MN, was the industrial connection and involved in study proposal, brace procurement, and paper writing/editing. CW was involved in all phases of the research project. NC was involved in all phases of the research project.

Corresponding author

Correspondence to Sebastian Tomescu.

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Conflict of interest

Authors ST and NC have received research grant support from Ossur Inc. Authors ST, RB, MK, NC are affiliated with the institution that received the grant. Author MN is an employee of Ossur Americas.

Funding

This study was funded by Ossur Inc (Grant no. RA060075).

Ethical approval

This study was approved by the University of Waterloo Office of Research Ethics (ID# T1504-1).

Informed consent

Informed consent was obtained from all participants included in the study.

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Tomescu, S., Bakker, R., Wasserstein, D. et al. Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain. Knee Surg Sports Traumatol Arthrosc 26, 526–533 (2018). https://doi.org/10.1007/s00167-017-4794-1

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  • DOI: https://doi.org/10.1007/s00167-017-4794-1

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