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BrJ Sp Med 1991; 25(3)
Evaluation of knee braces in Swedish ice hockey
players
Y. Tegner MD, PhD' and R. Lorentzon MD, PhD2
1 Department ofOrthopaedics, The Ermeline Clinic, Lulea, Sweden
2 Department ofOrthopaedics, University Hospital ofUmea, Umea, Sweden
In this retrospective investigation we have determined the The purpose of this investigation was to determine
rate and types of knee injuries among Swedish ice hockey the number of hockey players of elite and first
players, and related these data to the use of knee braces. division calibre who had knee injuries. We also
Thirty-seven of the originally selected 50 hockey teams wanted to relate these injuries to the use of functional
(74%) of elite or first division calibre took part in the knee braces and to find out whether knee injuries
study, and 600 players answered a questionnaire. A total occurred while wearing a brace.
of 254 previous knee injuries sustained while playing
hockey were reported by 243 players; tears of the medial
collateral ligament (60%), meniscus (15%) or anterior Material and methods
cruciate ligament (12%) were the most commonly reported All teams playing in the two highest divisions of the
injuries. Prophylactic knee braces were worn by 138 (23%) Swedish ice hockey league were selected for this
of the players. Of these, 122 (88%) had earlier sustained a
knee injury, and 16 had not. A total of 17 knee injuries had study. A total of 50 teams was included. The players
occurred while the players were wearing a brace. Six of in 12 of these teams (the elite teams) are semi-
these players had previously uninjured knees while 11 professional hockey players, while those of the first
had repeat injury in a brace despite earlier successful division teams, in most cases, are pure amateurs. We
rehabilitation or operation. The most common injury in prepared a comprehensive questionnaire which was
braced knees was a tear of the medial collateral ligament. distributed by the team physicians to all players. It
We conclude that the number of knee injuries is high contained questions about previous knee injury, type
among Swedish ice hockey players, and that the efficacy ofinjury, treatment, the use of a knee brace, and type
of functional knee braces to reduce knee injuries is of brace. After a group briefing, the players, one by
questionable. one in cooperation with the physician, completed the
Keywords: Functional knee brace questionnaire. All knee injuries that had occurred
during the players' hockey career were to be reported
Ice hockey is inherently associated with many but only those that had been diagnosed by a
potential dangers, because of the fast and random physician were registered. The players were especial-
nature of the game with frequent and often forceful ly asked if knee injuries had occurred when wearing a
contact between players1-3. A high incidence of knee brace.
injury during hockey games has recently been
demonstrated3 but major injuries were rare (8%), Results
complete tear of knee ligaments being the most A total of 600 players answered the questionnaire.
common severe injury. According to insurance These players belonged to 37 ofthe originally selected
statistics, knee injuries account for approximately 50 teams (74%). The players in nine out of 12 elite
30% of all injuries that result in significant disability teams answered.
and handicap4. In an effort to prevent or to minimize A total of 254 previous knee injuries sustained
these serious injuries, or to prevent repeated injury, during hockey play were reported (42% of the
orthotic braces for the knee have been developed and players). The most commoninjuries were a tear ofthe
marketed. These braces have gained widespread use medial collateral ligament (60% of all injuries), a
in hockey players despite the paucity of scientific meniscal lesion (15%) or a tear of the anterior cruciate
documentation on their efficacy. ligament (12%) (Table 1).
The treatment of players wearing braces was as
follows: players with medial collateral ligament
Address forcorrespondence: Y. TegnerMD, PhD, Department of injuries were all treated without surgery and had
Orthopaedics, The Ermeline Clinic, PO Box 195, S-951 23 LuleA, thus an instability in their knees. All meniscus lesions
Sweden were treated with arthroscopic meniscectomy. Play-
C 1991 Butterworth-Heinemann Ltd. ers with posterior cruciate injury were also treated
0306-3674/91/030159-03 without surgery. Of the 27 patients, 18 with anterior
Br J Sp Med 1991; 25(3) 159
of knee braces in Swedish ice hockey players: Y. Tegner and R. Lorentzon
Evaluation
Table 1. Types of knee injuries in 243 ice hockey players the 138 players using the brace, 122 (88%) had earlier
sustained a knee injury, and 16 had not. A total of462
Type of injury No. % players were not using a brace, and 130 (28%) of
them had had a previous knee injury. The present
Tear of use of knee brace in relation to previous knee injury
Medial collateral ligament 154 60.8 diagnoses is shown in Table 2.
Meniscus 38 15.0 Seventeen new knee injuries had occurred while
Anterior cruciate ligament 31 12.3 the players were using a brace (Table 3). Six players
Meniscus and medial collateral ligament 15 6.0 wearing a functional brace as pure prophylaxis had a
Posterior cruciate ligament 3 1.2 knee injury in previously uninjured knees. Five of
Fracture 5 2.0 medial collateral ligament
Patellar dislocation 2 0.2 these players sustained
Miscellaneous 6 2.5 injuries, and one a tear of the anterior cruciate
Total 254 ligament. Eleven players had repeat injury despite
wearing a knee brace. Four of these 11 injuries
occurred in anterior cruciate-deficient knees. Two
cruciate ligament injury had had surgery. Some of cases had a subluxation resulting in Grade I-II medial
them still had a demonstrable instability after the collateral ligament injuries, one case had a tear of the
operation. medial meniscus, and another case had a successful
The indication for bracing the players was thus in anterior cruciate ligament reconstruction ruined. The
some instances purely prophylactic and in some remaining seven players who had repeat injuries had
instances in the light of a demonstrable rotatory earlier had a tear of the medial collateral ligament.
instability. In most of the cases the brace was used to Five of these had a new tear of the medial collateral
protect a previously injured knee. currently ligament, one a tear of the medial meniscus, and one
Amongthe600hockeyplayers, 138 (23%) an unspecified major knee injury.
used a derotation brace to protect one or both knees.
The brace most frequently used was the Swedish Discussion
Knee Brace (LIC, Solna, Sweden) (Figure 1), which is
a modification of the Lennox Hill derotation brace. Of This investigation reveals a high number of signifi-
cant knee injuries among Swedish ice hockey players
of elite or first division calibre. Thus, in a population
of 600 players, 243 (40.5%) had sustained a knee
injury during hockey play. Although most injuries
are Grade II-III medial collateral ligament tears, even
more serious knee injuries might occur by the same
type of trauma. Therefore, there is definitely a need
for an effective prophylactic knee brace in ice hockey
players.
Table 2. Number of players using a knee brace, in relation to
previous knee injury diagnoses
Type of injury No. using No. not
brace usingbrace
Tearof 69 83
Medial collateral ligament 8 30
Meniscus 27 4
Anterior cruciate ligament 12 3
Meniscus and medial collateral
ligament ligament 3 0
Posterior cruciate 3 10
Miscellaneous
Total 122 130
Table 3. Knee injuries in players wearing a brace
Type of injury No. ofplayers
Tearof ligament 12
Medial collateral 2
Medial meniscus ligament 2
Anterior cruciate 1
Figure 1. Swedish Knee Brace, which is a modification of Unknown
the Lennox Hill derotation brace, was originally designed Total 17
to protect anterior cruciate ligament deficient knees
160 Br J Sp Med 1991; 25(3)
ofkneebracesinSwedishicehockeyplayers: Y. TegnerandR. Lorentzon
Evaluation
The efficacy of functional knee braces to protect the in this study. Nor is it possible to determine any
knee in hockey players has hitherto not been change in severity of knee injuries introduced by the
reported. On the other hand, there are several braces. To be able to make accurate comparisons
studies evaluating the effectiveness of prophylactic between players wearing, or not wearing, knee
knee braces in American football players5-10. Four of braces, a large study population must be prospective-
these studies found a reduction of medial collateral ly followed.
ligament injuries associated with using a brace, while We can conclude, however, that the number of
two of them reported increased knee injury inci- knee injuries among Swedish elite hockey players is
dence. No consensus arises from these studies high and that most of the knee-injured players do
because ofconflicting results as well as methodologic- wear a brace and, at the present time, the injury-
al problems'1. The number of knee injuries among preventive effect of the knee braces is questionable.
hockey players wearing a knee brace seems to be Today there is no persuasive evidence to recommend
unacceptably high. Despite bracing, serious knee the use or to advise against functional braces as
injuries do still occur in previously uninjured knees prophylactics to reduce knee injuries in ice hockey
as well as in earlier injured, but fully rehabilitated, players.
knees.
The efficacy of a knee brace is certainly dependent
upon its design and stability. The brace most
commonly used by Swedish hockey players has been
investigated earlier in goniometric and biomechanical References
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Br J Sp Med 1991; 25(3) 161
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