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Abstract

Introduction: With 100,000 to 200,000 cases reported in the U.S. yearly, the anterior cruciate ligament (ACL) is a commonly torn structure in the knee among contact and non-contact sports. As medical research on ACL injuries grows, ACL reconstruction (ACLR) continues to be the preferred surgical intervention. Due to extensive rehabilitation timeline requirements, ACLR patients may face physical and psychosocial circumstances affecting their overall recovery. At any point in rehabilitation the patient may experience kinesiophobia, or an irrational fear relating to further injury from participation in physical movement, especially with return to running, jumping, and sports-specific programs. Functional bracing has been an option for intervention to decrease fears of buckling and instability. However, they are argued to foster reliance, creating muscle atrophy and decreased knee extension velocity. As best evidence based practice develops on ACLR patients and effective interventions, functional bracing is currently challenged as an assistance or hindrance to overall recovery. Patient Information: Athlete is a 16-year-old softball catcher who underwent isolated bone patellar tendon bone ACL reconstruction in June 2022. She not only experienced the physical complications of recovery, but also faced ongoing psychosocial factors from early to late stages of her rehabilitation. From fears of engaging in physical activity without her brace to the financial burdens of the equipment, the athlete poses a significant case regarding bracing use and kinesiophobia levels. Interventions: Post-surgery, the athlete was taken through a standard rehabilitation protocol focusing initially on extension mobilization and quadriceps activation with progressions. She received clearance from her physician to run and jump at 4 months and to begin softball-specific activity at 6 months. Her physician instructed her to use the functional brace for running, jumping, and softball activity during the first season of play. At months 4, 6, and 10, the athlete completed hop testing and ACL-RSI measurements to track her progress in return to sport. To gradually prepare the athlete for softball catching, a deep knee flexion squat was also used to gauge her symptoms and abilities with therapeutic interventions. Outcomes: While the athlete successfully returned to sport for softball hitting and as first baseman after 6-7 months, she continued to report psychosocial uncertainties that affected her performance. At 4 months, her baseline ACL-RSI was 44.2%. With each re-evaluation, this score slowly progressed to 64.2% at 6 months and 82.5% at 10 months. Additionally, her overall hop test outcome that allowed return to sport at 6 months was 91.6%. However, this score was achieved with her brace. The athletic trainer noted the athlete’s kinesiophobia with non-braced activity, so she was slowly weaned from functional brace outside of softball participation. At 10 months, hop testing was performed again without her brace with an overall score of 80%. Clinical Bottom Line: Functional bracing usage has been highly debated in ACL reconstruction patients. While clinical practice has shifted away from using them, some clinicians and patients may prefer to use them in reintroduction of sports activity. Although functional braces have shown to be disadvantageous in patient’s progressive tissue loading, comfortability, finances, and self-efficacy with long-term use, it is appreciable to consider the proprioceptive effects the external support may give patients with higher kinesiophobia levels when reintroducing running, jumping, and other sports activity. In doing so, the patients may address psychological hesitancies and build confidence in physical movements. However, it is crucial that if a functional brace is incorporated into therapeutic intervention, the rehabilitation team must work to wean the patient out of the brace to aid appropriate strength, neuromuscular control, and self-confidence in his or her abilities apart from the brace.

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