Knee bracing proven to be ineffective in preventing knee injuries for football players
Knee bracing: popular measure lacking concrete evidence
Knee injuries are a major concern for football players of all levels, from high school athletes all the way up to the professional level, as they are considered the most common injuries sustained in the sport. More specifically, injuries to the medial collateral ligament (MCL) are of particular interest since studies show it's the first ligament to be ruptured upon impact, and therefore the most injuries occur there. These injuries can have a substantial impact, sidelining players and negatively affecting academics as well as quality of life (QoL), which makes them an important matter of focus. Knee bracing is one popular tactic used for the prevention of MCL and other knee injuries, but controversy exists on its actual effectiveness. According to the American Academy of Orthopedic Surgeons (AAOS), prophylactic knee bracing may provide limited protection against injuries to the MCL in football players, but there is insufficient scientific evidence to actually recommend the use of braces. In an attempt to better understand the effectiveness of knee bracing for preventing MCL injury, a systematic review was conducted.
Search criteria seek out specific set of studies
Articles reviewed were systematically selected from a number of databases and only included in the study if they were a level 1 randomized controlled trial (RCT, the most powerful study), or a well-done prospective cohort study (the next-highest level of evidence.) The initial search produced 22 articles, 10 of which were excluded because they dealt with other subject matters, leaving 12 articles. Of these, they found one RCT and five cohort studies, which became the data used for this review. The sole RCT was performed at the U.S. Military Academy and followed 1,396 cadets playing full-contact intramural football, who were randomly assigned knee braces and closely followed for signs of injury. Of the cohorts, two assessed high school and three assessed Division I NCAA football players. The study design in each of the prospective cohort studies was different, but each evaluated the subject matter of knee bracing for MCL injury prevention.
Some signs of effectiveness, but overall findings still inconsistent
The single RCT performed on cadets at the U.S. Military Academy found bracing to significantly reduce MCL and overall knee injuries, with 25 injuries in the non-braced group and 12 in the braced group. The reduction was based on position, with braced defensive players having significantly fewer injuries than those of controls, while there was no significant difference found with offensive players. Of the other five prospective cohort studies, however, results varied on a number of scales, with certain studies showing no significant differences between bracing and non-bracing groups, and one study reporting that the rate of all ligament injuries actually increased when the brace was used. Minimal data did sow show that in high-risk positions of offensive and defensive line, linebacker and tight end, bracing may be effective in both preventing and decreasing the severity of MCL injuries in the college athlete, but evidence did not support bracing for high school athletes.
There were a number of limitations on the RCT, including the fact that the subject group was military cadets in an intramural setting, which may not be generalizable to other at-risk populations, and the limited height and weight of the players. These limitations take away from the power of the study's findings, which is compounded by the flaws of the cohorts. Each of the other cohorts suffered from some form of bias that influenced their conclusions and generalizability, which makes their findings also unusable. Therefore, based on these studies, it's difficult to make an evidence-based recommendation about brace wear. Though there was one fairly positive RCT reviewed, it suffered from limitations, and the fact that the other cohorts provided evidence that was so contrasting and inconsistent makes reaching a conclusion on knee bracing that much more difficult. Therefore, it appears accurate to conclude that, based upon current evidence, prophylactic knee bracing therefore cannot be recommended to prevent or lessen the severity of MCL injuries in football players.
-Summarized by Greg Gargiulo
-As reported in the September/October '10 edition of Sports Health
