Concerns About ACL Rehab: Can Long-Term Brace Use Cause Muscle Atrophy?

"Slipped while rehabilitating the anterior cruciate ligament."

Hello Doctor, two months ago I asked about "slipping while rehabilitating my anterior cruciate ligament." At that time, the doctor said I could remove the knee brace only after I could fully extend my leg while sitting.
I still cannot fully extend it; I'm still a bit short.
However, the reconstruction surgery is still six months away.
Is it bad to wear the brace for such a long time? The physical therapist mentioned that my knee circumferences differ by 1.5 cm (there's still swelling; would it be more if there were no swelling?), and my thigh circumferences differ by 4.5 cm (it was a 2 cm difference before I slipped).
Will wearing the knee brace for an extended period cause muscle atrophy? (Recently, after wearing the brace for a longer time when going out, I've noticed a shallow dark red mark resembling a bruise where the straps were when I sit down and take it off.) Is the muscle atrophy just a residual effect you mentioned? Can I try not wearing the knee brace and see if I can walk slowly on the treadmill while holding on for support? Thank you for your response.

kimochi, 40~49 year old female. Ask Date: 2012/05/22

Dr. Shi Guozheng reply Orthopedics

When the knee joint cannot support weight, it is safer to wear a brace.
Muscle atrophy is inevitable, but the most important thing is to start rehabilitation as soon as possible to facilitate recovery.
You can try to walk a little.

Reply Date: 2012/05/22

More Info

Concerns about the rehabilitation process after an ACL (anterior cruciate ligament) injury are quite common, especially regarding the long-term use of a knee brace and its potential effects on muscle atrophy. It’s understandable to be worried about the implications of prolonged brace use, particularly when you are experiencing differences in muscle circumference and discomfort.

To address your concerns, let's first discuss the role of a knee brace in ACL rehabilitation. A brace is typically used to provide stability and support to the knee joint, especially in the early stages of recovery. It helps prevent excessive movement that could lead to further injury while the ligament heals. However, extended use of a brace can indeed lead to muscle atrophy, particularly in the quadriceps and hamstring muscles surrounding the knee. This is because the brace may limit the natural range of motion and discourage the use of those muscles, leading to a decrease in strength and size over time.

In your case, the measurements indicating a difference in circumference between your knees and thighs suggest that muscle atrophy may be occurring. The fact that you have experienced bruising or discoloration where the brace has been applied could also indicate that the brace is too tight or that it is causing localized pressure, which can further complicate your recovery.

While it is crucial to follow your physician's and physical therapist's recommendations, it is also important to engage in rehabilitation exercises that promote muscle strength and flexibility. If your physical therapist has advised you to keep the brace on while seated, it is likely to ensure that you do not inadvertently stress the knee. However, if you feel comfortable and your healthcare provider agrees, you might consider gradually reducing the use of the brace during low-impact activities, such as walking on a treadmill while holding onto the handrails for support. This can help stimulate muscle engagement and promote circulation, which is essential for recovery.

It’s also important to communicate openly with your healthcare team about your concerns. If you feel that the brace is hindering your recovery or causing discomfort, discuss this with your physical therapist or orthopedic surgeon. They may be able to adjust your rehabilitation plan, suggest alternative support options, or provide specific exercises to help mitigate muscle atrophy.

In summary, while long-term brace use can contribute to muscle atrophy, it is essential to balance the need for stability with the necessity of engaging the muscles around the knee. Gradual reintroduction of movement and strength training, under the guidance of your healthcare team, can help you recover effectively. Always ensure that any changes to your rehabilitation plan are discussed with your medical provider to ensure safety and efficacy in your recovery process.

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