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Looking for advice on ACL braces

post #1 of 21
Thread Starter 
So I'm three weeks into life without a left ACL, and making slow, steady progress. The bad news is my surgery is a few months off due to the wait lists here, but there's a silver lining: my PT thinks that given my progress so far, and with lots of hard work, I might still be able to catch a few late spring days at Whistler.

However, this means I need an ACL brace. (I know there's a bit of debate about the merits of these, but my PT is rock solid on the fact that I shouldn't ski without one and I trust his opinion.) Ideally I'd like to get one that will do me through the period between now and surgery, and get me through rehab and the first season back on the slopes. My insurance will cover 80%, so custom isn't a problem.

I don't know a lot about ACL braces. The Donjoy Defiance seems popular but gets mixed reviews over on the knee injury forums where I've been hanging out. Townsend Design's Rebel  has been highly recommended for skiing, but I'm not sure if they have a distributor in Vancouver. Donjoy, Breg and GII are easy to get here. There may be other options I don't know about.

I'd be grateful for feedback and recommendations from anyone who's spent some time in an ACL brace. Thanks in advance!
post #2 of 21
You might look here:

I met one of the guys who's the principal in this company.  I have not used these before but a lof the guys that I used to ride with bought these and loved them.  While not designed specifically for skiing, it may be a piece of equipment that will cross over nicely for you.  The founders of the company used to manufacture the CTi knee braces that required a Dr's perscription and were custom made for each individual.  Those braces were like $2,000 per pair.  The idea behind the cell braces was to deliver the same type product direct to the customer without Dr's perscription and at a more affordable price.  While they're $599 per pair, I think you can order just one.  You might call them and talk to them about skiing as an application for their product.  My guess is that you wouldn't be the first one to make that inquiry.

Again, I've never used these and therefore this is not an endorcement of any sort.  I'm just showing you something else that you might want to look at.

Best of luck. 
post #3 of 21
I've had a custom Donjoy Defiance that was ultra light. I had some problems with a hinge and it was replaced at not cost, so there customer service has been good.

I most recently had a CTI off the shelf brace (other knee ) and it performed well. The gizmo that was tied to the hinge to adjust tension dynamically didn't last that long, but the brace still functioned well without it.

A word about braces. You see people with braces over their ski clothing as if they are a fashion statement. These people are only fooling themselves into thinking they are protecting themselves. With multiple layers of fabric between the skin and brace, there is not chance in hades that they are getting good support from the brace. I typically wore my over my long johns. When I was racing, it went over a speed suit and I would have to adjust it throughout the day; it wouldn't fit under the suit, you also can't adjust it if it is under a speed suit.

The only problem I had from using a brace, other than mechanical issues noted above, was chafe. The reason I wore mine over my long johns was to reduce chafe. Your PT can provide you with a sleeve that you can use for protection so I used it when mt. biking and relied on the long johns for the same function when skiing.

Don't cinch the brace too tightly thinking tighter is better. It reduces circulation and increases the likelihood of chafe.

It sounds like you have a good PT that is interested in you and your success. I'm glad to hear that you are making good progress. Enjoy your time back on the snow this season. Take care. Ski well.
post #4 of 21
Gotta love socialized medicine! 
post #5 of 21
Our system is not a good one either. Those that can afford the premiums and out of pocket expenses, the wealthy, get great care. Then there are the rest of us.

I have a huge deductible as I can't afford the premiums for a lower deductible. As it is now, my premiums are breaking my bank account. If I had an knee injury I'd seriously have to decide whether to repair it or leave it alone. Not just a decision of getting a reconstruction or surgery, but whether I could go to the ER for x-rays, much less an MRI.

Until medicine is accessible and in the reach of all the patients and not bastardized by the lawyers, ours is a broken system. What got passed recently may not be the answer, but it ought to be a wake up call that something needs to change or we, as a society, will have even greater disparity  and animosity between the rich and the rest of us.
post #6 of 21
Thread Starter 
The wait list for surgery is frustrating enough, but socialized medicine really screwed me on the MRI. I'm paying $1000 to have one done privately because the wait list was 4-5 months - just to get the scan to get on the surgical wait list.  Can't really afford it, but balancing the cost vs. the risk of doing additional damage to the knee made it worth finding the money. I already have early stage OA in that knee, so an extra 5 months walking around without an ACL wouldn't be smart.

Thanks for the brace recommendations - it's good to hear a bit of first-hand experience, and to get an idea of some other products to look at. I've got a few weeks to make a decision, as I wouldn't be able to ski before May at the earliest. The cell braces do look like a possibility, and I'd like to find out more about using them for skiing.

I'm also baffled by people who put braces over layers and layers of clothing. I used GII trainer braces while recovering from a previous injury; snug leggings underneath definitely made them more comfortable, but even the thicker cycling pants I used in the winter stopped them feeling quite as supportive. Not entirely sure what kind of fashion statement an ACL brace makes, either...
post #7 of 21
I am truly sorry to hear about your knee issues.  Also, I do apologize for the snide remark regarding socialized medicine.  I am just very frustrated by our current administration and what is happening regarding health care in the US.  I just shudder when I hear stories about how things are in Canada and that we are headed down that path. 

Good luck with your knee! 
post #8 of 21
I find that most of the custom ACL braces are specifically designed to brace for the fore-aft "drawer test movement".  I use an off the counter Donjoy brace which offers more all round support.  I've skied hard with no ACl for 15 years.

Incidentally, I am now covered by both the Canadian and US systems.  My ACL went undiagnosed for so long because the out of pocket costs in the US were so high that we took the wait and see approach, and finally decided not to pay for the MRI.  Like most people, I would not give up my Canadian care for the US system.  One can find numerous shortfalls in each, and everyone is entitled to their opinion. but as a dual citizen, Obama is doing just what I elected him to do.  Democracy in action.  I don't see how we could make things much worse in the US.   
post #9 of 21
Different strokes for different folks!
post #10 of 21
You see people with braces over their ski clothing as if they are a fashion statement. These people are only fooling themselves into thinking they are protecting themselves.
The same might be said for many of those who wear a knee brace under their ski clothing.

Multiple well-designed clinical studies have shown no advantage to bracing a knee with either an intact or reconstructed ACL; however, there is some objective evidence that a knee brace may offer some protection to an ACL-deficient knee like your knee, kxcd, which has a torn ACL that has not yet been surgically repaired.

As for the type of brace, though one can find many varying opinions, there is no objective data that favors one brace over another. In fact, clinical studies have failed to identify any knee brace that's better than just a simple neoprene sleeve, perhaps because whatever protection against further injury a brace may offer isn't dependent upon it enhancing or stabilizing the knee.
post #11 of 21
Thread Starter 
Thanks for the additional advice. My PT did acknowledge that after surgery, the brace may be as much about confidence as about stability - especially when I first get back on the slopes. He definitely wants me in one for the time between now and surgery, which makes sense.
post #12 of 21
My wife has used a custom Donjoy since her ACL surgery last year without incedent. According to the person that fit her, if you can fit any clothing underneath it, it's too loose, and won't work.

I also have several friends with Donjoys who MTB regularly with them, Never heard a complaint about the brace, except that they scratch their bike frames from rubbing. And they are expensive, if your not covered.
post #13 of 21
When I was at the ortho and we diagnosed my injury, one of the first things he told me was absolutely get the brace.  The Breg rep happened to be there and took measurements to custom fit it there.

The ortho said the brace is essential for skiing and anything athletic I do from now on.  PT said the same.  He said the biggest benefit is that it won't allow you to fully extend the knee, which is when most acl injuries occur.  That was the case with my injury.   It also prevents twisting and unnatural sideways movement to some degree.

I've read alot on the internet that says there is no data one way or the other that it works to prevent an acl injury, but I would tend to trust my ortho.  the guy is an engineer as well as a Dr., has been employed in proffesional sports and I'm guessing knows a bit more than the average blogger.

Everything I've read says to definitely wear it for support if you are going to ski without an ACL.  Thats your call, but I would think you are taking the chance of damaging your meniscus further just to get a few turns in before the season ends.  I know it sucks, but I would stick to the prehab and make sure you get the best result when you have your surgery. 

In the past, I've had some patelar tendonitis and I started wearing one of those neopreen type braces with the metal hinges in the side.  I always wear them when I ski.  There is no question that it cut down on the soreness from the tendonitis and it helped me get through the season almost pain free.  I'm living proof that it does jack shit for your ACL as I was wearing it when I was injured. 

I've got a buddy who had an ACL injury and never had surgery.  He wears the Breg style brace from about 10 years ago and swears by it.   He won't ski if he doesn't have it.

I would say, why not wear one.  There is no evidence that it is harmful and if it provides confidence and any measure of protection then why not.
post #14 of 21
It is a bit like the MSM-Glucosamine debate. No 'scientific proof', you it sells well most I speak to that use it, myself included (ya I talk to myself a lot, no one else will listen), say they gain significant benefit from it.

I've also had braces (as mentioned earlier) and they do help restrict certain bad movements, they do help the knee stay better aligned and most of all, they provide proprioperception which seems to help.
post #15 of 21
Exaclty.  My regular Dr. told me to take glucosamine for patellar tendonitis and handed me an article that said matter of fact that it works and how to dose it correcily.   I did just what it said and didn't notice any difference.  I'm taking it now though for my injury just in case it does work.  I found one with boron which I believe reduces inflammation.  It can only help.  I told myself I will take it everyday all year and hope it helps.
post #16 of 21
Thread Starter 
I'll add glucosamine to my list of things to try, and see if it works. My partner takes it for some long-standing neck pain and says it really helps; I just hadn't thought of trying it myself because the nature of the injury is so different.

I honestly haven't made a decision on skiing at the end of this season yet, and won't until much nearer the time. My PT is excellent, so I'm letting him be the guide on what I should and shouldn't be doing. He hasn't led me wrong yet and I'm really happy with my rehab progress, especially the fact that I'm back to regular 30k bike rides less than 4 weeks after injury. As for skiing this season, he did make it very clear that while it's not an unrealistic goal, it will depend on my progress over the next six weeks. He won't okay me if he doesn't think it's the right thing to do. Right now, I'm certainly not counting on it - but it's a very motivating goal to keep me in the gym and working away on those exercises. 
post #17 of 21
To my understanding Glucosamine/Chondroitin/MSM are for joint pain from cartilige issues. It may not assist with ligament damage. You are actually very lucky to have survived an ACL rupture without meniscus damage. They almost always go hand in hand.
post #18 of 21
sounds like you're much better off than I was 4 weeks after if you were biking 30k.  Then again you were probably in better shape to begin with.  haha.  No really, I could only ride the exercise bike about 20 min. without resistance.  I had no power in my quad and the joint was really loose.  I just worked on getting as much quad strength back and ROM as I could before surgery.  I couldn't imagine skiing the way it was. 
post #19 of 21
Thread Starter 
MastersRacer - yeah, I breathed a huge sigh of relief when I saw that on the MRI report. My PT and doctor both think I had an undiagnosed partial tear on that side from an injury four years ago, which is why it went so easily this time. There was no big twist or wrench when I fell; the knee just bent too far, under pressure, and gave way. The right knee was actually under slightly more pressure, and was fine. I'm guessing either the lack of twist or the fact that the ACL was already partially torn made the injury less damaging to the internal structures than would normally have been the case.

Vermonte - I've been surprised by how quickly the knee has stabilized, particularly in comparison to the last injury when the knee would regularly give way and dump me on the floor. I keep comparing this experience to that one, and I'm amazed by how much quicker my recovery has been given that this is a more serious tear. I suspect it's a combination of my PT's aggressive approach to rehab and the fact that I was in really good shape this time, whereas I was in really poor shape before. I have lost most of the power in my quad, though; we're working pretty hard on trying to get some of that back.
post #20 of 21
Thread Starter 
Got my brace - an Ossur Paradigm. It's very lightweight and comfortable and my PT checked it out pretty thoroughly and is really happy with the support it's providing for my leg. Now I just have to go try an activity where I need it, and see how I get on!
post #21 of 21
I just got mine today.  It is Donjoy, but looks exactly like the Breg one in the link I posted earlier.  Also very light and comfortable.  Compared to the one I've been wearing since the surgery, this thing is a Cadillac.  It will only let the knee extend to 10 deg. which will keep the ACL from becoming to taught. I think that is primarily why my Dr. said to always wear it skiing.  It does provide alot of lateral support as well.  It makes a big difference walking around in it as compared to the post op brace.
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