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DrZoidbergAnnnnnd the thread title should read skiing without the brace, as I've been skiing with it for the last five years or whatever.
SteezMcGeeI wanna say try to strengthen your knee again first, and then take off the brace. However I also wanna say for you to get a medical professional to make the diagnosis.
californiagrownidk why its taken you so long to ditch it? its a 100% mental thing now.
californiagrownidk why its taken you so long to ditch it? its a 100% mental thing now.
dan4060I wear mine because it could prevent a hyper-extension. I don't need it anymore, but it could help me in a worst case scenario. It is more than a mental thing, it could actually help me and does not hurt me. I train a lot and I don't need it for support, but like I said it could help me in a bad crash. I don't wear it running or surfing anymore, as those sports are far less likely to be a problem. My PT told me that i would eventually not need it for anything, but that it could help in the worst case scenario so I wear it because of that. My Dr. told me the same thing. I am a decade out of surgery. I don't need it, but I might as well get the extra protection.
It sounds like the problem might be that the brace does not fit well.
californiagrownSure. It's like any other brace or body armor at that point. It's there in case something goes really, really wrong, but it does hinder natural movement. And that hindrance cam be anywhere from unnoticable, to annoying, to disabling.
reBlockeThe braces don't do anything other than act as a mental reminder (in the treatment of ACL tears). If your tibia moves far enough in relation to your femur that your brace is what stops it, your ACL is long gone. There is no convincing evidence that they help even in the immediate post-operative period ( http://www.ncbi.nlm.nih.gov/pubmed/24169301 ), and they definitely aren't required 5 years later.
My physio's advice back when I tore mine was to get a neoprene sleeve to wear as a mental reminder (and maybe some extra warmth) for the first couple days, then ditch it.
If your knee feels unstable this far out, it's either a.) all in your head or b.) it's actually unstable, in which case you need to hit the gym and get those hamstrings firing again - which a brace is only going to inhibit.
dan4060He said he didn't wear the brace all the time, just for skiing. Your link was interesting, but it does not address reinjury, which is why I still wear mine.. My Dr. and therapist recommended me wearing the brace because it could prevent a hyper-extension. I only wear it for skiing, not anything else, so it has not inhibited anything. I will take their advice and continue wearing it when I ski. I only ski 30-35 days a year, so most of my muscle is built in the gym and running hills. I don't wear a brace for that, because the risk of hyper-extension is not very high.
reBlockeHyperextension is not how you would re-injure your ACL skiing - it would be twisting of the tibia in relation to the femur head. Braces theoretically could help stabilize this, but that effect is not seen in the real world (see discussion below).
To be fair, there is still some disagreement among PT/Orthopods. So here's the deal:
That review does include safety (=reinjury) as an endpoint. Here's another review that more explicitly states the point. ( http://sph.sagepub.com/content/7/3/239.long )
"Eleven studies in the initial review evaluated this question, and no study demonstrated a clinically significant or relevant improvement in safety, range of motion including extension, or other outcome measures [note: this includes re-injury]. Given these studies and the expense of postoperative bracing, we do not include bracing following ACL reconstruction as part of our protocol. This was reinforced by an additional 6 studies published since 2005. None of these demonstrated an advantage from bracing."
And a skier specific discussion can be found here - http://www.jospt.org/doi/full/10.2519/jospt.2012.4024
"There appears to be overwhelming evidence in the current literature that does not support the use of functional knee braces when returning to sport.5,7,19,29,31,37 The current position of the US ski team is that the use of functional knee braces is physician dependent. We recommend using a brace for 1 year, after which the decision to continue bracing during skiing is left to the athlete. Although a systematic review of 12 randomized controlled trials performed in 2007 by Wright and Fetzer45 found no evidence that pain, range of motion, graft stability, and protection from subsequent injuries were affected by the use of braces, we refer to 2 specific ski studies for supporting evidence. Kocher et al24 found that nonbraced skiers were 6.4 times more likely to sustain a knee injury, such as a meniscal tear, chondral injury, or medial collateral ligament tear, than unbraced ACL-deficient knees. Sterett et al41 found that subsequent injuries on ACL-reconstructed knees in professional skiers were 2.74 times more likely to occur on unbraced knees."
Those last two studies are NOT randomized - meaning they just looked at who wears a brace vs who doesn't. Is someone who wears a brace more likely to ski more conservatively and/or rehab more cautiously than someone who doesn't? Definitely. So there is no way to isolate the effect of bracing from the effect of being the type of person that wears a brace. This is why non-randomized studies are not acceptable evidence for determining which treatment to use - they are only for generating hypotheses that should be later tested in an randomized trial. Trials have been run on braces and they indicated no benefit, but they have not specifically been done on skiers (primarily because randomized control trials are extremely expensive and nobody is going to make any money off of telling people to not brace their knees)
TLDR: you can either trust two inadequate studies specific to skiers supporting bracing, or a multitude of adequate studies across a variety of sports that do not support it.
Your doctor and physio recommend the brace because it is the "standard of care", meaning it is what other physicians commonly do and it is probably what they were taught when they went through school/residency - NOT because there is good evidence for it. This protects them from a lawsuit if you were to re-injure your knee and try to sue them for whatever reason. Not to shit on doctors - I'll be one in May (hence my interest in this type of thing)- but this is one example of where the data does not support common practice.
Thanks for posting. I will check these out when I have time. I don't however agree that skiers who wear braces are necessarily more cautious after the first year. I can see the logic, but I would not want to definitively state it without a study. I would agree that braced skiers are more likely to ski cautiously during the first year, I just don't know if they would afterwords. I would agree that they would be more likely to rehab cautiously, I just don't know about the skiing part. Like I said, I would be curious to see a study about this so that I could evaluate the methodology and the results.
Did the studies you are posting consult statisticians? If not they should have. I'm not saying they have reached false conclusions, and like I said I have not looked at them yet. I have seen numerous studies reach spurious conclusions because the people who are in charge don't know how to properly evaluate statistics. In many cases it takes a professional to do that. Economists tend to be very good at it, so do physicists. Biologists tend to be okay, although there are some biologists who have made contributions to statistics. People in fields like sociology tend to be horrible. When I read a sociology study I take everything with a grain of salt. Lots of them took one stats class and think they know enough to evaluate their findings, they usually don't. Scientists take more math and thus are usually able to wrap their brains around results more effectively than those in the social sciences. But the bottom line is that those outside statistics should always consult a professional. They should do so before and after the study. Unfortunately many of them don't.
I am a fellow of the society of actuaries with an M.S. in statistics, so I actually know what randomized means, and yes, I don't see how you could run a randomized experiment on something like this. Unfortunately I would think that studies like this would be observational, although I would have to look over yours to see for sure. Like I said, I don't see how you could do an experiment on something like this, as you can't tell some people to wear one and some people not to, then perform tests. It is like smoking, with most studies you simply have to observe, you can't tell people to smoke, which would be your treatment, you can only observe the effects of something on smokers vs. nonsmokers. You can't really assign treatments to people in this case, they will just wear a brace or not. That's unfortunate, but I don't see any way around that. I wear the brace not just for my ACL, but for anything else that has to do with my knee. Like I said, it could prevent a hyper-extension, which is reason enough to wear it regardless of whether it helps the ACL or not. When my doctor told me to wear it he did say that it could prevent other injuries, so that is a large part of why I am doing it.
The one thing I don't like is the cost statement. I'm going to do something regardless of the cost, within reason. $1,000 is not a big price to pay for something that might well increase my safety, so I don't think that should be included in the decision making. My insurance paid for most of it, but I would have gotten it anyway.
Anyway, thanks for posting. I will check it out when I get a chance.
californiagrownIn that case why do you not have 2 knee braces, a leatt neck brace, a pressure suit and couple shoulder braces? Haha.
Obviously I'm exaggerating, but I'm sure you get what I mean. Everyone has to decide if the possible protection is worth the loss of mobility, cost, and general PITA that various protection devices require.