Adjustable Hinged Knee Bracing Does Not Improve Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta‐analysis of Randomized Controlled Trials

Purpose To determine whether the use of an adjustable hinged knee brace during the early postoperative period after anterior cruciate ligament (ACL) reconstruction provides measurable benefits compared with no bracing in terms of patient‐reported outcomes, knee stability, muscle strength, range of motion, and complication rates. Methods Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, a systematic search of PubMed, Ovid Medline, and Scopus was conducted through May 2025. Only Level I randomized controlled trials comparing adjustable hinged knee bracing versus no bracing after primary ACL reconstruction were included, and studies were excluded if they used any other brace type, lacked postoperative outcomes, or were nonclinical designs. Pooled effect sizes were calculated using fixed‐ or random‐effects models based on I 2 heterogeneity, with mean differences and odds ratios reported with 95% confidence intervals. Methodological quality was assessed using the Modified Coleman Methodology Score and the Risk of bias 2 tool. Results Six randomized controlled trials (384 patients) met inclusion criteria. The mean follow‐up duration across the included trials was 21 months (range, 3‐60 months). Meta‐analyses showed no statistically significant differences between bracing and no bracing groups for Lysholm score (MD = −0.48; P = .72), isokinetic extension (MD = 0.06; P = .97) or flexion torque (MD = 2.15; P = .30), range of motion, or reoperation rate (OR = 0.61; P = .18). Rerupture rates were also comparable (brace: 2.9% vs no brace: 3.6%; P = .79). A small but statistically significant difference in side‐to‐side difference anterior tibial translation using instrumented arthrometers (e.g., KT‐1000 or equivalent), favored the brace group (MD = −0.20 mm; P = .01); however, this was not clinically meaningful. Return to sport outcomes, including anterior cruciate ligament‐return to sport after injury scores and time to sport resumption, were similar between groups (22‐33 weeks). Conclusions The use of an adjustable hinged knee brace early after ACL reconstruction did not statistically significantly improve patient‐reported outcomes, muscle strength, range of motion or rates of reoperation and re‐rupture compared with no brace, although it did provide a small but statistically significant improvement in anterior knee stability. Level of Evidence Level I, meta‐analysis of Level I studies.