前十字韌帶重建術後穿戴膝護具之必要性探討—系統性回顧與統合分析

Background and Purpose: Bracing for support and protection after anterior cruciate ligament (ACL) reconstruction has been a common practice, and most of the clinicians would recommend wearing the brace after the surgery to their patients a decade ago. Recent studies, however, found that wearing the brace might not provide additional benefits for better recovery. The purpose of this study is to investigate whether wearing the brace is necessary after ACL reconstruction. Methods: We searched literature and selected articles with randomized or clinical controlled trials that compared wearing the brace with no-brace in the rehabilitation program after ACL reconstruction for this review. Outcome measures included range of motion (ROM), knee laxity, isokinetic peak torque, one-leg hop, Lysholm functional score, Tegner activity level. and complications during the short and long term follow-up periods. Results: Six studies were included and the total number of subjects was 310. Meta-analysis revealed the improvements of knee fiexion ROM (effect size, d=0.394) was significantly better in the no-brace group during the first 6 months after surgery. And peak isokinetic flexion torque of slow speed (d=0.440, 0.338) were also significantly better in the no-brace group during the 6 months and first year after surgery. Knee laxity, one-leg hop performance, and complications were not different between the two groups in the short and long term follow-ups. Moreover, our review showed that the Lysholm functional score and the Tegner activity level were better in the no-brace group during the short term follow-ups but the difference was not significant after 12 months. Conclusions: Wearing the brace after ACL reconstruction did not guaranty better improvements. On the contrary, patients without wearing a brace during their rehabilitation demonstrated better improvements in ROM and muscle strength during the first 6 months after the surgery.