Most athletes who suffer an ACL injury of their knee undergo surgery in order to return to sports. What if an athlete wants to play now? Can he wear an ACL brace and play with a torn ACL? In my latest Ask Dr. Geier column, I address this question from the parent of a young athlete who wants to delay surgery and play in a brace instead.

Ijeoma Tiggs in Rock Springs, Wyoming asks:

Hi Dr. Geier,
I have a question for you regarding ACL repair and re-tear. My son (16-year-old football player) tore his ACL in September 2014, and on October 10, 2014 he underwent repair and progressed very nicely without any complications. He is able to sprint (not at full speed, he has not been cleared to do that yet), able to jump and land. He is back to weightlifting with the team (trying to reach black shirt level, squatting 225lbs with no pain to his right knee). Overall the orthopedic surgeon was very happy with his progress.

On April 4, 2015 he was throwing the football with no hitting or contact and went to do a cut and felt a crunch to his right knee. Needless to say, we had an MRI and it read that he had torn his ACL graft right at the femur where it attaches to the bone.

My son is very upset and wants to play this year. His football team, brothers and coach are counting on him because he is so good. He is smart as well (3.7 GPA). He eats and drinks football. He wants to play this season and then after the season go back for surgery.

Is there a brace he can wear to stabilize his knee until surgery? He feels no pain, has full ROM, and nothing has changed (if we didn’t know any better we would not know that his graft was torn). We desperately need your knowledge. We understand that the #1 goal is a healthy knee, but for now is there a brace that will stabilize his knee enough to let him play?

That is a great question, and I certainly understand his desire to play. I can’t give him specific advice, but I do have some thoughts on this dilemma for all athletes.

Also read:
ACL injuries and deciding when to have surgery
Young athletes risk further damage by delaying treatment for ACL injuries

Generally athletes with an ACL-deficient knee, either after an ACL tear or rupture of an ACL graft, have an unstable knee. If he runs and plants the foot to change directions, the knee might buckle. If he lands from a jump, his knee might give way. Not only would it be difficult to play with an unstable knee, he risks further damage, like meniscus tears and articular cartilage damage.

A custom ACL brace can provide some degree of protection to an athlete’s knee. It is not guaranteed that such a brace would completely prevent the knee from buckling with cutting, pivoting or landing movements. It could be better than playing without a brace, though.

Some athletes don’t have buckling or giving way with an ACL-deficient knee, so a custom brace might be a reasonable option. If the knee gives way in the brace, the athlete and his parents could then decide to have surgery. There are studies, however, that show higher rates of secondary damage to the knee in young athletes who elect nonoperative treatment of an ACL tear compared to those who undergo early surgery. It’s at least worth talking to a sports medicine orthopedic surgeon to discuss options appropriate, including an ACL brace, for the young athlete.

Also read:
Ask Dr. Geier: Nonoperative treatment of ACL tears
Sports medicine stats: Nonoperative treatment of ACL tears in children and adolescents

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