To Brace or Not to Brace?

A professional athlete who is recovering from knee surgery is likely to be fitted with a custom brace. Opinions vary, however, concerning the effectiveness of off-the-shelf, hybrid/semi-custom, and custom braces for the more typical patient who needs knee or ankle bracing. This uncertainty is attributable, in part, to the inconsistency of past research covering functional lower-extremity braces. Even when the ideal brace for a given patient is known, however, it cannot be prescribed unless the patient considers it affordable or the patient’s third-party payor considers its purchase reimbursable. Because economic considerations influence medical decisions, physicians and physical therapists can face serious obstacles in prescribing braces.

Off-the-Shelf Braces

• For the older population who may not have insurance coverage through Medicare.
• For the younger person who lacks insurance coverage.
• For the patient who may not have athletic aspirations and will return, following surgery or injury, to a desk job.
• Immediate fitting available. Patients do not have to wait to have the brace built.
• Inadequate for a patient whose thighs are too large or small for the available brace sizes.
• May be less comfortable than hybrid or custom braces.
• They are heavier and less attractive.
• They must be fitted by a thoroughly trained individual.

Hybrid Braces

Defined as a hybrid brace as a standard brace that can be modified to meet the patient’s need through changes in the brace’s padding and the angular relationships of its components.

• Available in a broader range of sizes.
• The materials used to make these braces generally incorporate elements of both custom and off-the-shelf braces.
• Less expensive than custom braces.
• Best for the postoperative patient needing protection and adjustment.

Custom Braces

• Fitted to the individual, based on multiple measurements.
• Fit difficulties can occur with edema, deconditioning or the addition of significant amounts of muscle.
• Indicated for individuals who have significant angulation at the joint or early return to work after injury.
• Very important to competitive athletes.
• Insurance is more likely to pay for a custom brace intended to reduce load bearing by the joint of a patient with arthritis.

In conclusion, one must evaluate the patient’s insurance coverage, activity needs, anatomical joint position, joint dysfunction type as well as the patient’s stage in recovery after surgery or injury, prior to prescribing or suggestion of a particular brace.