Functional knee brace alters predicted knee muscle and joint forces in people with ACL reconstruction during walking

Functional knee braces used during rehabilitation from injury and surgery to the anterior cruciate ligament (ACL) have been reported to provide a strain-shielding effect on the ACL in healthy people while standing, reduce quadriceps electromyography in ACL-deficient individuals, and alter joint torque patterns in people with ACL reconstruction during walking. These results led to the hypothesis that functional knee braces protect a reconstructed ACL during dynamic activity by reducing the anterior shear load applied to the knee. This hypothesis was tested by investigating the effects of a functional knee brace on lower extremity muscle forces and the anteroposterior shear force at the knee joint during the stance phase of walking in people with ACL reconstruction. Ground reactions and sagittal plane video were recorded from 9 ACL-reconstructed individuals as they walked with and without a functional knee brace, and from 10 healthy people without the functional knee brace. Inverse dynamics were used to calculate the net joint torques in the lower extremity during the stance phase. Hamstrings, quadriceps, and gastrocnemius muscle and knee anteroposterior shear force were then predicted with a sagittal-plane mathematical model. Compared to healthy individuals, those with ACL reconstruction walked with 78% more hamstrings impulse and 19% less quadriceps impulse (both p <.05). The functional knee brace produced an additional 43% increase in hamstrings impulse and an additional 13% decrease in quadriceps impulse in the ACL group. Peak anterior knee shear force and anterior impulse were 41% lower and 16% lower in ACL vs. healthy individuals, respectively. The functional knee brace further reduced the peak knee shear force and impulse 28% and 19%, respectively, in the ACL group. It was concluded that a functional knee brace protects a reconstructed ACL during walking by altering muscle forces and reducing the anterior shear force applied to the knee joint.