Exploring Predictors of Brace-Wearing Adherence in Non-Surgical Treatment of Acute Knee Medial Collateral Ligament Injuries

Abstract

Objectives: (1) To estimate adherence to brace wearing for medial collateral ligament (MCL) injuries across 3 phases of conventional treatment and (2) to explore predictors of adherence for each phase.

Design: Exploratory cohort study.

Setting: Primary care center.

Patients: Fifty-nine patients aged 18 to 65 (27 men, 32 women) from a randomized clinical trial examined the effectiveness of 2 bracing techniques (0-90 degrees or 30-90 degrees) for acute isolated MCL or combined anterior cruciate ligament injuries. Patients were prescribed a 6-week bracing protocol and were followed for 12 weeks.

Interventions: Patients were prescribed constant brace wearing for 4 weeks (∼23 h/d), then daytime wear only (∼15 h/d) until brace discontinuation at 6 weeks. Rehabilitation exercises were prescribed from 2 weeks onward. Adherence to the protocol was assessed through daily self-reported logs. Clinical and patient-reported outcomes were collected throughout the randomized clinical trial (baseline, 2, 4, and 6 weeks). This study interpreted them as predictor variables of treatment adherence alongside patient and treatment characteristics.

Main outcome measures: Adherence to each 2-week phase, interpreted dichotomously (adherer or nonadherer). Adherers were identified as those who wore their brace according to the protocol.

Results: Adherence and pain decreased, while overall knee ratings improved throughout the treatment. Pain, affected knee, and brace range-of-motion settings were significant predictors of adherence in the exploratory logistic regressions.

Conclusions: Pain, affected knee, and brace range-of-motion settings were the primary predictors of brace wearing in the first 4 weeks of treatment. This study is the first to provide insight into MCL bracing adherence, potentially aiding clinicians in treatment management.

Keywords: acute injury; adherence; compliance; knee; knee bracing; knee injury; medial collateral ligament; nonoperative management; sport medicine; treatment adherence.

Figure 1.

A, Proportion (%) adherence and nonadherence in each phase of the treatment protocol. B, Proportion adherence based on diagnosis (MCL or MCL–ACL) in each phase of the treatment protocol. C, Proportion adherence based on the assigned brace group (0–90 or 30–90) in each phase of the treatment protocol. D, Proportion adherence based on the affected knee (left or right) in each phase of the treatment protocol.

Figure 2.

A, Change in pain scores (on VAS) per phase of the protocol and adherence group. B, Overall knee ratings (SANE on VAS) per phase of the protocol and adherence group.