History of Knee Braces in Sports
For some coaches and athletes the term “knee brace” conjures the unpalatable image of Joe Namath and his big, bulky Lennox Hill brace from the seventies. However, the reality is very far from that. Knee bracing in sports has rapidly evolved over the past twenty-five years with braces becoming comfortable, highly functional and commonplace in many sports – not only to help athletes return after injuries, but to protect against certain injuries in the first place. The progress that has been achieved in bracing is important for high school coaches, trainers and athletes to carefully consider.
This improved efficacy of the knee brace, particularly on a prophylactic basis, is well documented by research and very evident in the wide usage of braces among college athletes and sports programs today. As demonstrated by the studies and other data discussed below, braces today are an important and valuable piece of equipment that should be evaluated as early as the high-school level of athletics.
Back in 1984 the most common knee brace was the single hinge lateral brace used primarily in football and it was not really designed to help players avoid injuries. In fact the American Academy of Orthopaedic Surgeons didn’t even consider injury avoidance as a primary function of knee braces due to its construction and studies of the day were split on its ability to prevent injuries. Today, however, multiple studies now show that modern braces have the ability to effectively control rotational forces which produce injuries in knee ligaments. The most significant development in that evolution has been the introduction of custom fit function knee braces.
What We Find in Studies:
It is important for physicians and athletic trainers to advise athletes appropriately relative to protective equipment. Recommendations for protection require understanding of biomechanics and anatomy. Prophylactic braces were initially designed to restrain abnormal knee motions, and the knee braces have now progressed to provide functional stability.
Proper application has shown effective with the laterally applied prophylactic lateral brace as there was a decrease in valgus force application to the knee joint, often the culprit of injury to medial knee structures Physicians and athletic trainers commonly use prophylactic knee braces to protect the knee from impact forces. The principal factors that determine the impact response characteristics of a brace-knee composite are force distribution, energy absorption, and energy transmission. Material properties and the mechanical design of the brace are important factors in determining brace response to impact. The impact response can be quantified by applying lateral loads to cadaver knees and surrogate knee models. With the knee in full extension, prophylactic braces are limited in their capacity to protect the medial collateral ligament from direct lateral stress. Laboratory studies, using a surrogate knee model, concluded that preventive braces absorb 15-30% of the energy of a direct blow.
Various authors have reported on the positive effect of prophylactic bracing on the incidence and severity of knee injuries while Grace et al., and Teitz et al. reported bracing increased knee injuries. To validate the impact of prophylactic braces on this population a retrospective investigation attempted to control many of the known biases and utilized a large sample from a variety of institutions.