Brace-free rehabilitation after isolated anterior cruciate ligament reconstruction with hamstring tendon autograft is not inferior to brace-based rehabilitation – a randomised controlled trial

Review written by Dr Christina Le info

Key Points

  1. There is no difference in self-reported outcomes of knee function, physical activity, health-related quality of life, or RTS confidence in a brace-based or brace-free approach early after ACLR with a hamstring autograft.
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Using a knee brace after anterior cruciate ligament reconstruction (ACLR) is thought to protect the graft from excessive stress and strain. Previous studies have examined post-operative bracing after an isolated ACLR with a bone-patellar tendon-bone autograft and found no additional benefit.

However, post-operative bracing following an isolated ACLR with a hamstring autograft has yet to be compared with brace-free care. As a hamstring tendon autograft lacks a bone-tendon interface, the graft remodelling process may require more time and, subsequently, benefit from the use of early post-operative bracing (1).

Therefore, the objective of this study was to compare clinical outcomes over 12 months following an isolated ACLR using a hamstring autograft in brace-based and brace-free rehabilitation groups.

There is no additional benefit of post-operative bracing after isolated ACLR with a bone-patellar tendon-bone autograft
There is mounting evidence that does not support the use of post-operative knee bracing.


This was a randomised controlled non-inferiority trial conducted in a single centre in Germany. Individuals scheduled for a primary, isolated ACLR with hamstring tendon autograft were recruited. Individuals with multi-ligament injuries, previous knee ligament or cartilage repair surgeries, severe osteoarthritis,

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