Abstract des Autors

This article provides a review of the progress that has been made on the biomechanical, functional performance and epidemiological investigations into the effectiveness of prophylactic knee braces (PKBs) since the position statement against their use was issued in 1987 by the American Academy of Orthopaedics and a review of this subject was last published in Sports Medicine in 1989 by Montgomery and Korziris. The evolution of the salient design features of three surrogate knee models are regiewed along with the results of PKB effectiveness and safety factor testing. While still too limited in scope to be totally realistic, major advances have been made in the sophistication of the present biomechanics laboratory testing conditions. The on-the-field functional performance effects of wearing a knee brace are not always manifest in all individuals. The efficacy of PKBs remains in question but recent studies have taught us enough to put their use into perspective. While they may play some role, PKBs probably represent the least important factor in influencing the likelihood that a medial collateral ligament (MCL) sprain will occur. On the other hand, there is no evidence that such braces put added valgus pressure on some knees, or that wearing a brace is associated with an increased frequency or severity of knee or ankle injury. All else being equal, from the biomechanical studies, we know that whilst some braces are better than others, currently available PKBs can provide 20 to 30% greater resistance to a lateral blow, with the possibility that the anterior cruciate ligament (ACL) is given even greater protection than the MCL. This appears to be true when the lateral blow is of sufficient magnitude to cause significant medial joint line opening, but is not as great at the very lowest levels of impact. Regardless of the material they are made of, the most effective PKBs are those suffiently stiff to prevent an external blow at the joint line from causing brace higne contact with the knee tissues. Based on the superior results of the custom-fit functional braces, the most important future design feature appears to be the sizing and fitting of the thigh and tibial cuffs. Verf.-Referat