Use of a Postoperative Brace After ACL Reconstruction in Recreational Soccer Players: Impact on Function, Strength, Pain, Kinesiophobia, Quality of Life, and Return to Sport

Abstract

Background: The use of postoperative bracing after anterior cruciate ligament (ACL) reconstruction remains a topic of debate. Although braces are widely prescribed to enhance joint stability and provide psychological support, their actual impact on functional outcomes, muscle strength, pain, kinesiophobia, quality of life, and return-to-sport (RTS) rates is unclear-particularly in recreational athletes. Purpose: To evaluate the effects of postoperative knee brace use on knee function, muscle strength, pain, kinesiophobia, quality of life, and RTS rates over a 12-month period in recreational soccer players who underwent ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 male recreational soccer players who underwent arthroscopic ACL reconstruction between 2020 and 2023 were included. Postoperative brace use depended on the clinical routines of 2 orthopaedic teams: one routinely prescribed a knee brace, while the other did not. Thus, patients were categorized into brace (n = 25) and no-brace (n = 25) groups accordingly. All patients followed the same standardized rehabilitation program. Assessments were performed preoperatively and at 15 days and 3, 6, and 12 months postoperatively. Outcome measures included the visual analog scale for pain, Tampa Kinesiophobia Scale, International Knee Documentation Committee score, Lysholm Knee Scoring Scale, isokinetic muscle strength testing at 60 deg/s and 180 deg/s, the 36-item Short Form Health Survey quality of life assessment, and RTS rates. Results: No statistically significant differences were found between the groups regarding pain, knee function, kinesiophobia, quality of life, or RTS rates at any time point (P > .05). However, baseline isokinetic extension torque at 180 deg/s was significantly higher in the brace group compared with the no-brace group (314.7 +/- 66.1 Nm vs. 279.7 +/- 59.6 Nm; P = .03). At the 12-month follow-up, this relationship was reversed, with the no-brace group demonstrating significantly greater extension torque at 180 deg/s than the brace group (340.8 +/- 62.2 Nm vs. 301.2 +/- 57.5 Nm; P = .02). Within-group improvements were observed over time in several parameters, but most did not reach statistical significance (P > .05). Brace use did not provide additional benefit in any of the evaluated outcomes. Conclusion: Postoperative bracing did not lead to improved clinical outcomes, including function, strength, pain, psychological readiness, or RTS success, in recreational soccer players following ACL reconstruction. These findings suggest that routine bracing may not be necessary in this population. Further prospective studies are needed to validate these retrospective observations.