The vast majority of torn anterior cruciate ligaments (ACL) can heal themselves with the help of a specialised knee brace, a small study has found.
A ruptured ACL is a common sports injury that is usually treated with reconstructive surgery to replace the torn ligament. Last year, at the University of Melbourne in Australia and her colleagues found that about 30 per cent of people who opted to defer surgery and try rehabilitation had some degree of ACL healing after two years.
In their latest study, Filbay and her colleagues tested a knee brace designed to promote healing by reducing the gap between the ligament鈥檚 two torn ends. The braced knee is immobilised at a right angle for the first four weeks and the patient exercises the muscles above the knee by clenching to reduce muscle wasting. Then the brace is adjusted to gradually increase the person鈥檚 range of knee motion over eight weeks, with more strengthening exercises added.
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The study included 80 people who attended a private exercise physician鈥檚 clinic in Australia with complete ACL ruptures. Ninety per cent had signs of ACL healing after three months of wearing the brace. MRI scans showed their ACLs regrew to form one continuous length, though the ligament was either skinnier, thicker or saggier than before injury.
鈥淚t was a very surprising and overwhelming number鈥� compared with the roughly one-third of people whose ACLs healed in the previous trial with only rehabilitation, says Filbay.
More than 90 per cent of people whose ACLs mended thick returned to their chosen sport within 12 months, as did 62 per cent of people with thinly healed or sagging ACLs. But 14 per cent of the entire group tore their ACL again within a year 鈥� which is in the same ballpark as .
Without a control group in the study, no direct comparisons can be made between using the knee brace, rehabilitation without one or outcomes following surgery, says Filbay. The team is planning two randomised clinical trials to compare the approaches directly.
鈥淐ertainly, these results suggest [knee bracing] helps to facilitate the spontaneous healing of the ACL,鈥� says at La Trobe University in Melbourne, who wasn鈥檛 involved in the work.
However, he cautions that people shouldn鈥檛 try knee bracing themselves without medical supervision. Immobilising the knee for a month comes with a risk of blood clotting and can also be functionally disabling: wearers can鈥檛 straighten their leg, walk, drive or possibly work. Bracing is 鈥渘ot for everyone鈥� and needs further long-term study, he says.
British Journal of Sports Medicine
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