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NCT Number: NCT06942754

Bracing and Reconstruction of the Anterior Cruciate Ligament for Efficacy Trial

Several attempts have been made to reduce these failure rates and improve return to sports rates in high-risk populations, and one of these approaches has been postoperative bracing. A recent survey of the Anterior cruciate ligament (ACL) Study Group has shown that 53% of surgeons prefers functional bracing following ACL reconstruction. Currently, however, there is no clear consensus on whether functional bracing following ACL reconstruction leads to lower failure rates, improved stability or better patient-reported outcomes when compared to ACL reconstruction without bracing.

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Key information

Age range

14 year–39 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Wake Forest University Health Sciences

Winston-Salem, North Carolina, 27157, United States

Location status: Recruiting

Location contact

Katherine Leonard

CONTACT

[email protected]

336-716-3952

About this study

Given the increased popularity in quadriceps tendon graft, the biomechanical advantages of postoperative functional bracing, and the graft elongation that occurs predominantly with soft tissue grafts, there might be a role for functional bracing following quadriceps ACL reconstruction. Additionally, no studies to date have assessed the role of psychological readiness of return to sport, kinesiophobia and return to sport rates with and without functional bracing following ACL reconstruction (ACLR).

The purpose of this randomized controlled trial is to assess the 2-year outcomes of psychological readiness, patient-reported outcome measures (PROMs), clinical stability, return to sport and failure rates following quadriceps autograft ACL reconstruction with and without functional bracing in the postoperative phase in younger athletic patients and military patients with a higher risk of failure or not returning to sports or duty, respectively, in a randomized study: the Bracing and Reconstruction of the Anterior Cruciate Ligament for Efficacy trial (BRACE-trial).

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • patients with unilateral complete ACL injury
  • patients involved in sports and the desire to return to sports
  • patients undergoing quadriceps autograft ACL reconstruction
  • must be 14 to 39 years old

Exclusion criteria

  • multiligamentous knee injuries defined as two ligaments requiring surgical stabilization
  • concomitant suture tape augmentation, extra-articular tenodesis or anterolateral ligament reconstruction
  • concomitant femoral, tibial, or patellar fracture(s)
  • patients with significant osteoarthritis
  • concomitant ipsilateral knee dislocation or patellar dislocation
  • significant lower leg malalignment requiring correcting osteotomies
  • prior ACL surgery, including contralateral knee
  • pregnancy during injury or surgery
  • unable to provide consent
  • prolonged use of prednisolone or cytostatics
  • comorbidities (e.g., muscular, neurological, vascular) that influence rehabilitation

Treatment and study plan

post-surgical functional bracing

Device

Quadriceps Autograft ACL Reconstruction with the use of post-surgical functional bracing, using the DonJoy Defiance Pro brace

Other names: DonJoy Defiance Pro brace

Primary outcomes

  1. Change in ACL-return to sport index (ACL-RSI) Scores

    Time frame: Baseline and 3, 6, 12, and 24 months

    The ACL-Return to Sport after Injury scale (ACL-RSI) is a 12-item survey that measures psychological readiness to return to sport after an ACL injury or surgery. It uses a visual analog scale from 0 to 100, where higher scores indicate greater psychological readiness. The total score is calculated as a percentage of the 12-item total score.

    A higher ACL-RSI score indicates a greater level of psychological readiness for returning to sport.

Secondary outcomes

  1. Tampa Scale Kinesiophobia 11 (TSK-11) Score

    Time frame: Baseline and 3, 6, 12, and 24 months

    The TSK-11 (Tampa Scale for Kinesiophobia) is a 11-item questionnaire assessing fear of movement/re-injury, scored on a 4-point Likert scale (1-4) with a total score range of 11-44, where higher scores indicate greater fear of pain and movement.

    Lower scores (closer to 11): Indicate minimal or no kinesiophobia (fear of movement/re-injury).

    Higher scores (closer to 44): Suggest a greater degree of kinesiophobia.

  2. International Knee Documentation Committee (IKDC) Score

    Time frame: Baseline and 3, 6, 12, and 24 months

    The IKDC is a patient-completed tool, which contains sections on knee symptoms (7 items), function (2 items), and sports activities (2 items). Scores range from 0 points (lowest level of function or highest level of symptoms) to 100 points (highest level of function and lowest level of symptoms)

  3. Lysholm score

    Time frame: Baseline and 3, 6, 12, and 24 months

    The Lysholm Knee Scoring Scale is a 100-point questionnaire used to assess knee function and is often used to evaluate knee injuries and surgeries, with higher scores indicating better function and fewer symptoms.

    A higher score indicates better knee function and fewer symptoms. Scores are often categorized as excellent (95-100), good (84-94), fair (65-83), and poor (<65).

  4. Forgotten Joint Score (FJS-12)

    Time frame: Baseline and 3, 6, 12, and 24 months

    The Forgotten Joint Score (FJS-12) is a patient-reported outcome measure designed to assess how much a patient is aware of their artificial join in everyday life, with higher scores indicating less awareness and better surgical outcomes.

    Each response is assigned a score (0-4), and the scores are summed and transformed to a 0-100 scale, with higher scores indicating less awareness of the joint.

    Interpretation:

    A higher score suggests that the patient is less aware of their joint, indicating a better outcome and higher satisfaction with the surgery.

  5. SANE Score

    Time frame: Baseline and 3, 6, 12, and 24 months

    The SANE score asks the patient to rate the shoulder on a scale from 0 to 100, with 100 being the patient's normal. Although singular in nature, the SANE score incorporates broad intangible differences in patient-perceived function, quality of life, and goals.

    SANE scores range from 40% to 60% at baseline for most patients before treatment and range from 75% to 85% at 1 year after therapy depending on the condition

  6. 5-point Likert Scale for Surgery Satisfaction Score

    Time frame: Baseline and 3, 6, 12, and 24 months

    A 5-point Likert scale for surgery satisfaction typically uses a range from "Very Unsatisfied" to "Very Satisfied" with options like "Very Dissatisfied," "Dissatisfied," "Neutral," "Satisfied," and "Very Satisfied". This scale allows patients to express their level of satisfaction with various aspects of their surgical experience.

    Very Dissatisfied/Very Unsatisfied (1): Indicates a very negative experience. Dissatisfied/Unsatisfied (2): Indicates a negative experience. Neutral (3): Indicates neither satisfaction nor dissatisfaction. Satisfied (4): Indicates a positive experience. Very Satisfied (5): Indicates a very positive experience.

  7. Pain Visual Analog Scale (Pain - VAS) Score

    Time frame: Baseline and 3, 6, 12, and 24 months

    a measurement tool used to gauge subjective experiences, especially pain, by having individuals mark a spot on a continuous line between two defined extremes, representing, for example, "no pain" and "worst pain".

  8. Lachmeter

    Time frame: Baseline and Months 3, 6, 12, and 24

    A Lachmeter is a device that is attached above and below your knee, that will measure the laxity (looseness) of your knee.

  9. Lachman pivot shift

    Time frame: Baseline and 3, 6, 12, and 24 months

    The Lachman, pivot shift tests are all physical examination techniques used to assess the integrity of the anterior cruciate ligament (ACL) in the knee.

  10. Lachman anterior drawer

    Time frame: Baseline and 3, 6, 12, and 24 months

    The Lachman anterior drawer tests are all physical examination techniques used to assess the integrity of the anterior cruciate ligament (ACL) in the knee.

  11. Tegner Activity Score

    Time frame: Baseline and 3, 6, 12, and 24 months

    The Tegner Activity Scale (TAS) is a simple, self-administered questionnaire that assesses a patient's level of activity, both at work and in sports, on a scale of 0 to 10The TAS is a 1-item questionnaire scored on a scale of 0 to 10.

    0: represents maximum disability due to knee problems, such as being on sick leave or disability.

    10: represents participation in competitive sports at a national or international elite level, like soccer.

  12. Time to Return to Sport/Previous Activity Level

    Time frame: Months 3, 6, 12, and 24

    Time to Return to Sport/Previous Activity Level

  13. Y-Balance Distance

    Time frame: Months 6, 12, and 24

    asked to reach a maximum distance in 3 different directions (shape of a "Y") - do this while standing on 1 leg and staying balanced. Both legs will be tested

  14. Number of Single Hop

    Time frame: Months 6, 12, and 24

    asked to perform a maximum single leg broad jump - 2 reps on each leg

  15. Number of Triple Hops

    Time frame: Months 6, 12, and 24

    asked to perform a single leg triple hop (hop forward 3 times in a row) - 2 reps on each leg

  16. Biodex Strength Testing

    Time frame: Months 6, 12, and 24

    measure the strength of your thigh muscles (quadriceps and hamstrings) - kick leg forward and pull leg backward as hard as possible - perform this assessment at 1 to 2 different speeds (the machine controls the speed). Both legs will be tested.

  17. Reoperation Rate

    Time frame: Months 3, 6, 12, and 24

    Reoperation Rate

  18. Failure Rate

    Time frame: Months 3, 6, 12, and 24

    Failure Rate

  19. Brace Compliance Rate

    Time frame: Months 6, 12, and 24

    While wearing the brace, the sensor will track how many hours the brace is in use. The goal of the sensor is to track compliance of wearing the brace during rehabilitative and sport (or military) specific activity.

  20. Number of Brace Complications

    Time frame: Months 6, 12, and 24

    Number of Brace Complications

Study contacts

Contact information is provided by the study sponsor or research team.

Katherine Leonard

CONTACT

[email protected]

336-716-3952

Sponsors and collaborators

Lead sponsor

Wake Forest University Health Sciences

Other

Registry information

Official study title

Bracing and Reconstruction of the Anterior Cruciate Ligament for Efficacy Trial (BRACE-trial)

Acronym: BRACE

Important dates

Study start
2025
Primary completion
2028
Study completion
2028
First posted
Apr 24, 2025
Registry last updated
Apr 1, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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