title: Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study.
abstract: BACKGROUND
  It is unclear what factors contribute to knee joint effusion after anterior cruciate ligament (ACL) injury and reconstruction. Knee homeostasis after injury and surgery is crucial for rehabilitation and knee well-being. We examined if effusion was affected by post-operative bracing, and if patients with effusion fit into a common profile.
  
  
  METHODS
  Patients were randomized to wearing or not wearing a post-operative brace for three weeks after ACL reconstruction with semitendinosus-gracilis tendons. Knee joint effusion was detected by computed tomography in 60 patients (22 women), before and three and 12 months after surgery. Joint effusion, clinical and subjective tests were analyzed.
  
  
  RESULTS
  This is the first prospective, randomized study on post-operative bracing for patients with a semitendinosus-gracilis graft showed that bracing had no effect on three-months presence of joint effusion. Excessive joint effusion was present in 68% of the patients three months after surgery and was associated to prior meniscus injury (p=0.05) and higher prior Tegner activity level (p=0.006). We found a positive association between longer time from injury to surgery and joint effusion three months post-operatively (rho=0.29, p<0.05). Twelve months post-operatively, joint effusion had diminished to baseline levels. Subjective scores and activity levels were lower for women. Three-months joint effusion predicted lower final outcome scores in women.
  
  
  CONCLUSIONS
  Prior meniscus injury and pre-injury Tegner activity levels are predictive significant variables for excessive knee joint effusion after ACL reconstruction. Post-operative bracing had no effect. A larger clinical cohort is needed to confirm findings of this logistic regression.
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden. Electronic address: Maria.C.Lindstrom@ki.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Lindström
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Torsten
authors.initials: T
authors.lastname: Wredmark
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hopsital at Huddinge, Stockholm, Sweden.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Wretling
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marketta
authors.initials: M
authors.lastname: Henriksson
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Li
authors.initials: L
authors.lastname: Felländer-Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001915:Braces; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D065466:Lysholm Knee Score; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brace; Effusion; Hamstring graft; Knee function; Rehabilitation