Appendix A

In the active pediatric population, the two most commonly injured areas for which braces have been used are the knee and ankle. One might have seen those football offensive linemen with large mid-thigh-to-calf hinged knee brace. Basketball players may be lacing up ankle braces on top of taped ankles and underneath those high-cut shoes. These are used for both acute and chronic conditions. For some athletes, they may gear them up for purely “cosmetic” reasons. The role and effectiveness of bracing for prevention and treatment of musculoskeletal injuries remain controversial; however, because of positive responses from the users, and minimal side effects, they are still widely used.1

Braces have generally been categorized into the following types: (1) prophylactic, to prevent or reduce severity of injury, (2) functional, to provide stability, and (3) rehabilitative, to augment postoperative care and recovery. A prophylactic knee brace is used to prevent injury; for example, the medial collateral ligament (MCL) injury during a valgus stress, or cruciate ligament sprains during a rotational stress (Figure A-1). Some find it cumbersome, but for athletes who are at high risk for such injuries (i.e., football offensive linemen, defensive linemen, linebackers, tight ends), might feel that this gives them a sense of protection.

###### Figure A-1

Unilateral hinged brace used for knee collateral ligament injuries.

A functional knee brace is used to provide stability to the joint; for example, control of knee joint rotation and anteroposterior translation for an anterior cruciate ligament (ACL) deficient knee.2 This brace can come in the hinge-postshell or the hinge-poststrap types. It has an extension stop to guard against hyperextension. It has been recommended for select patients, including those who have poor motor control and proprioception with the intention that the brace will increase their spatial awareness and better anticipate an impending event.3

A rehabilitative or postoperative brace is most commonly used for post-ACL reconstructive surgery and the nonoperated ACL-deficient knee. It is also used after repair of PCL, MCL, LCL, meniscus, or in managing nondisplaced epiphyseal fractures.4 This type of brace has bilateral bars that span the thigh and leg with adjustable hinges at the knee that have extension and flexion stops to control the range of motion. This allows for different postoperative rehabilitation protocols. The use of this brace might not change the outcome of ACL reconstruction but it is still commonly used during the vulnerable postoperative period as it offers some protection from external forces and helps remind the patient of the risk of graft failure.3 In 2001, the American Academy of Pediatrics released a technical report stating it does not recommend prescribing prophylactic knee braces because of the ...

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