The Effectiveness of Prophylactic Knee Bracing in American Football: A Systematic Review

CONTEXT: Knee injuries, particularly of the medial collateral ligament (MCL), are the most common injury sustained in American football. In 1979, Anderson et al described a knee brace that could protect uninjured knees from MCL injuries resulting from lateral impact. Since then, a number of light and free-moving bracing devices have been developed. However, the efficacy of prophylactic knee bracing remains in question. OBJECTIVE: A systematic review of the efficacy of prophylactic knee bracing in preventing MCL injuries in football players. DATA SOURCES: Based on MedSearch and PubMed, articles from 1985 to November 2009 were identified with the following keywords and their combinations: prophylactic, prevent injury, knee brace, prevention, medial collateral ligament, MCL, football, and bracing. STUDY SELECTION: One randomized controlled trial (level 1 study) and 5 prospective cohort studies (level 2 studies) were selected. RESULTS: The results of the studies were inconsistent; only 1 study showed that prophylactic knee bracing significantly reduced MCL injuries (P < .05). In contrast, 2 studies found that knee bracing was associated with an increase in knee injuries. CONCLUSIONS: Prophylactic bracing in American football has not consistently reduced MCL injuries. There remains a lack of evidence to support the routine use of prophylactic knee bracing in uninjured knees. There is limited high-level evidence, bias in the available literature, and confounding variables that limit the current literature.