Summary Results of this two-group parallel design randomised controlled trial indicated one and two year outcomes following ACL reconstruction were not different in one hundred and fifty patients using either an ACL functional knee brace or neoprene knee sleeve. Introduction: The primary objective of this study was to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve

One hundred and fifty patients were randomised to receive an ACL functional knee brace (n=76) or a neoprene sleeve (n=74) at their six week postoperative visit following primary ACL reconstruction. Patients were instructed to wear the knee orthosis during participation in all physical activities. Patients were assessed preoperatively, six weeks, six, twelve, eighteen and twenty-four months postoperatively. Outcome measures included disease-specific quality of life (ACL QOL), KT 1000 and single limb forward hop test administered by a blinded research assistant. One and two-year outcomes were compared after adjusting for baseline scores. A priori directional subgroup hypotheses based on time from injury to surgery, pre-operative KT 1000 scores, and one and two-year compliance scores were evaluated using tests for interactions. Analysis was completed on an intention-to-treat basis.

There were no significant between-group differences for any of the outcomes at one and two-year follow-ups. Mean between-group differences at two years were: 2.87% (95% CI: −3.85 – 9.60) for the ACL QOL, 0.07mm (95% CI: −0.80 – 0.93) for KT 1000 side-to-side difference, and 2.64% (95% CI: −4.57 – 9.85) for hop limb symmetry index. There were no significant subgroup findings and adverse events were similar between groups.

Confidence intervals for between-group differences are narrow and exclude clinically important differences. These findings suggest a functional knee brace does not result in superior outcomes over a neoprene sleeve following ACL reconstruction.

The peak external knee adduction moment during walking gait has been proposed to be a clinically useful measure of dynamic knee joint load in patients with knee osteoarthritis. However, there is limited information about the reliability of this measure, or its ability to detect change. The test-retest reliability and sensitivity to change of peak knee adduction moments were evaluated in thirty patients with varus gonarthrosis. Indices of relative and absolute reliability were excellent (intra-class correlation coefficient = 0.85, standard error of measurement = 0.36 % BW*Ht), and the sensitivity to change following high tibial osteotomy was high (standardized response mean = 1.2).

To estimate the test-retest reliability, measurement error and sensitivity to change of the peak knee adduction moment during gait.

Thirty patients (44”11 yrs, 1.7”0.09 m, 87”20 kg, twenty males, ten females) with varus gonarthrosis underwent gait analyses on two pre-operative test occasions within one week, and on a third test occasion six months after medial opening wedge high tibial osteotomy. Three-dimensional kinematic and kinetic gait data were collected during self-paced walking and used to calculate the peak knee adduction moment.

An intraclass correlation coefficient of 0.85 (95%CI: 0.71, 0.93) indicated excellent relative reliability, and a standard error of measurement of 0.36 %BW*Ht (95%CI: 0.29, 0.49) indicated low measurement error. The peak knee adduction moment after surgery (1.66”0.72 %BW*Ht) was significantly (p< 0.001) lower than before surgery (2.58”0.72 %BW*Ht). A standardized response mean of 1.2 (95%CI: 0.77, 1.6) indicated the size of this change was large.

Based on 95% confidence levels, these results suggest the error in an individual’s peak knee adduction moment at one point in time is 0.70 % BW*Ht, the minimal detectable change in an individual’s peak adduction moment is 1.0 %BW*Ht, and it is sensitive to change following treatment.

The peak knee adduction moment during gait has appropriate reliability for use in studies evaluating the effect of treatments intended to decrease the load on the knee. When considering measurement error, the knee adduction moment is also appropriate for clinical use in evaluating change in individual patients.

Funding: CIHR, Arthrex Inc.